Provider Demographics
NPI:1063517274
Name:FLEUR DE LIS OB/GYN ASSOCIATES
Entity type:Organization
Organization Name:FLEUR DE LIS OB/GYN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:BOUCHER
Authorized Official - Last Name:COURET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-832-5500
Mailing Address - Street 1:3040 33RD STREET
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001
Mailing Address - Country:US
Mailing Address - Phone:504-832-5500
Mailing Address - Fax:504-832-5531
Practice Address - Street 1:3040 33RD ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-2036
Practice Address - Country:US
Practice Address - Phone:504-832-5500
Practice Address - Fax:504-832-5531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1442453Medicaid
LA7847263OtherAETNA
LA=========OtherCHAMPUS
LA7847263OtherAETNA