| New Haven Family Medicine | |
|
333 S Ryan St Suite 120 Lake Charles LA 70601-5821 | |
| (337) 493-8480 | |
| Not Available |
| Full Name | New Haven Family Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 333 S Ryan St, Lake Charles, Louisiana |
| Authorized Official Name and Position | Anthony Kehinde Adeosun (OWNER) |
| Authorized Official Contact | 3374938480 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Haven Family Medicine 333 S Ryan St Suite 120 Lake Charles LA 70601-5821 Ph: (337) 493-8480 | New Haven Family Medicine 333 S Ryan St Suite 120 Lake Charles LA 70601-5821 Ph: (337) 493-8480 |
| NPI Number | 1174773881 |
|---|---|
| Provider Enumeration Date | 09/30/2008 |
| Last Update Date | 09/30/2008 |
| Medicare PECOS PAC ID | 3971661208 |
|---|---|
| Medicare Enrollment ID | O20081015000320 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174773881 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Anthony K Adeosun |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568570653 PECOS PAC ID: 1850382516 Enrollment ID: I20081015000307 |
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