Provider Demographics
NPI:1124254164
Name:PHYSICIAN UTILITIES, INC
Entity type:Organization
Organization Name:PHYSICIAN UTILITIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:M
Authorized Official - Last Name:KITAKULE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACP
Authorized Official - Phone:337-364-8500
Mailing Address - Street 1:2309 EAST MAIN STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-0000
Mailing Address - Country:US
Mailing Address - Phone:337-364-8500
Mailing Address - Fax:337-364-8582
Practice Address - Street 1:2309 EAST MAIN STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-0000
Practice Address - Country:US
Practice Address - Phone:337-364-8500
Practice Address - Fax:337-364-8582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11988R207RC0200X, 207RP1001X
LAMD.11988R207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DK25Medicare PIN