Provider Demographics
NPI:1144279134
Name:NORTHLAKE PULMONARY ASSOCIATES INC.
Entity type:Organization
Organization Name:NORTHLAKE PULMONARY ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KUEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-892-9143
Mailing Address - Street 1:1203 S TYLER ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2353
Mailing Address - Country:US
Mailing Address - Phone:985-892-9143
Mailing Address - Fax:985-892-9656
Practice Address - Street 1:1203 S TYLER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2353
Practice Address - Country:US
Practice Address - Phone:985-892-9143
Practice Address - Fax:985-892-9656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RC0200X, 207RP1001X
LA207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1943223Medicaid
5D509Medicare ID - Type Unspecified