Provider Demographics
NPI:1548283906
Name:LOBUE, ANGELO K (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:K
Last Name:LOBUE
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 1:15800 PROFESSIONAL PLZ
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1453
Mailing Address - Country:US
Mailing Address - Phone:225-345-2180
Mailing Address - Fax:985-345-5586
Practice Address - Street 1:15800 PROFESSIONAL PLZ
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1453
Practice Address - Country:US
Practice Address - Phone:225-345-2180
Practice Address - Fax:985-345-5586
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008651208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1081817Medicaid
LA1081817Medicaid