Provider Demographics
NPI:1124434428
Name:M'LISS HOGAN MD, LLC
Entity type:Organization
Organization Name:M'LISS HOGAN MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/AGENT
Authorized Official - Prefix:
Authorized Official - First Name:M'LISS
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-898-1106
Mailing Address - Street 1:110 LAKEVIEW DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7511
Mailing Address - Country:US
Mailing Address - Phone:985-898-1106
Mailing Address - Fax:
Practice Address - Street 1:110 LAKEVIEW DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7511
Practice Address - Country:US
Practice Address - Phone:985-898-1106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.203311208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty