Provider Demographics
NPI:1063525889
Name:SIBILIA, GALENO (MD)
Entity type:Individual
Prefix:
First Name:GALENO
Middle Name:
Last Name:SIBILIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301A YOUNGSVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-4524
Mailing Address - Country:US
Mailing Address - Phone:337-837-3615
Mailing Address - Fax:337-839-8097
Practice Address - Street 1:301A YOUNGSVILLE HWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4524
Practice Address - Country:US
Practice Address - Phone:337-837-3615
Practice Address - Fax:337-839-8097
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD13399R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1545619Medicaid
LA1545619Medicaid
E20103Medicare UPIN