Our Lady of the Lake Physician Group LLC

NPI #1033494943 in Baton Rouge, Louisiana

Provider Information

NPI Number: 1033494943
Entity Type: Organization
Organization Name: Our Lady of the Lake Physician Group LLC
Primary Specialty: Internal Medicine
Enumeration Date: Oct 12, 2011
Last Updated: Oct 8, 2015

Practice Location

Address: 7777 HENNESSY BLVD
Address 2: STE 6002
City: Baton Rouge
State: Louisiana
ZIP Code: 70808-4300
Phone: (225) 765-7727

Authorized Official

Name: JEFFREY LIMBOCKER
Title: CFO
Phone: (225) 765-7727

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Allergy & Immunology	207K00000X
Dermatology	207N00000X
Family Medicine	207Q00000X
Medical Genetics - Clinical Genetics (M.D.) — Clinical Genetics (M.D.)	207SG0201X
Otolaryngology	207Y00000X
Pediatrics	208000000X
Physical Medicine & Rehabilitation	208100000X
Plastic Surgery	208200000X
Psychiatry & Neurology - Psychiatry — Psychiatry	2084P0800X
Surgery	208600000X
Colon & Rectal Surgery	208C00000X
Hospitalist	208M00000X
Physician Assistant	363A00000X
Nurse Practitioner	363L00000X
Internal Medicine	207R00000X	Primary

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