Provider Demographics
NPI:1902873813
Name:SUMMERSGILL, LOUIS EDMUND (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:EDMUND
Last Name:SUMMERSGILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2710
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70459-2710
Mailing Address - Country:US
Mailing Address - Phone:985-646-0691
Mailing Address - Fax:985-646-0750
Practice Address - Street 1:1001 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2939
Practice Address - Country:US
Practice Address - Phone:985-646-0691
Practice Address - Fax:985-646-0750
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13057R2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1576719Medicaid
MS00120880Medicaid
LA5E542Medicare ID - Type Unspecified
LA1576719Medicaid