Provider Demographics
NPI:1902281538
Name:MUTHULINGAM, THANASEELAN
Entity Type:Individual
Prefix:
First Name:THANASEELAN
Middle Name:
Last Name:MUTHULINGAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 CINCINNATI ST
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232-3007
Mailing Address - Country:US
Mailing Address - Phone:318-878-5171
Mailing Address - Fax:318-878-6446
Practice Address - Street 1:407 CINCINNATI ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:LA
Practice Address - Zip Code:71232-3007
Practice Address - Country:US
Practice Address - Phone:318-878-5171
Practice Address - Fax:318-878-6446
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA321097207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program