| Imperial Medicine Llc | |
|
1800 Irving Pl Shreveport LA 71101-4608 | |
| (318) 425-4096 | |
| (318) 425-8438 |
| Full Name | Imperial Medicine Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1800 Irving Pl, Shreveport, Louisiana |
| Authorized Official Name and Position | Deanna Mossallati (MEMBER MANAGER) |
| Authorized Official Contact | 3184254096 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Imperial Medicine Llc Po Box 64568 Phoenix AZ 85082-4568 Ph: (318) 424-5449 | Imperial Medicine Llc 1800 Irving Pl Shreveport LA 71101-4608 Ph: (318) 425-4096 |
| NPI Number | 1629504220 |
|---|---|
| Provider Enumeration Date | 05/03/2017 |
| Last Update Date | 05/03/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629504220 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 303623 (Louisiana) | Primary |
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