Provider Demographics
NPI:1497005375
Name:GASTROENTEROLOGY CLINICS OF LOUISIANA
Entity type:Organization
Organization Name:GASTROENTEROLOGY CLINICS OF LOUISIANA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JATINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:AHLUWALIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-246-4600
Mailing Address - Street 1:4400 AMBASSADOR CAFFERY PKWY STE A
Mailing Address - Street 2:#287
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6760
Mailing Address - Country:US
Mailing Address - Phone:337-246-4600
Mailing Address - Fax:
Practice Address - Street 1:119 RUE FOUNTAINE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5744
Practice Address - Country:US
Practice Address - Phone:337-246-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD204884207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty