Provider Demographics
NPI:1194763870
Name:CHAUDRY, IMRAN IFTIKHAR (MD)
Entity type:Individual
Prefix:
First Name:IMRAN
Middle Name:IFTIKHAR
Last Name:CHAUDRY
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 1:3100 FORSYTHE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3014
Mailing Address - Country:US
Mailing Address - Phone:318-699-0505
Mailing Address - Fax:318-699-0506
Practice Address - Street 1:3100 FORSYTHE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3014
Practice Address - Country:US
Practice Address - Phone:318-699-0505
Practice Address - Fax:318-699-0506
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12477R207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1542245Medicaid
LAF81053Medicare UPIN
LA5A756Medicare PIN