Impact Physician Group, Louisiana LLC
NPI #1437775459 in Lake Charles, Louisiana
Provider Information
- NPI Number
- 1437775459
- Entity Type
- Organization
- Organization Name
- Impact Physician Group, Louisiana LLC
- Primary Specialty
- Internal Medicine
- Enumeration Date
- Jun 25, 2020
- Last Updated
- Jun 25, 2020
Practice Location
- Address
- 2720 RUE DE JARDIN STE 100
- City
- Lake Charles
- State
- Louisiana
- ZIP Code
- 70605-4050
- Phone
- (260) 407-8009
Authorized Official
- Name
- PAUL MILLER
- Title
- CREDENTIALING COORDINATOR
- Phone
- (260) 407-8009
Specialties & Taxonomy Codes
| Specialty |
|---|
| Internal Medicine |
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