Provider Demographics
NPI:1194920710
Name:ZADEH, SOUSAN LEHIMAGAR (DO)
Entity type:Individual
Prefix:DR
First Name:SOUSAN
Middle Name:LEHIMAGAR
Last Name:ZADEH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42388 PELICAN PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403
Mailing Address - Country:US
Mailing Address - Phone:985-542-6251
Mailing Address - Fax:985-345-2386
Practice Address - Street 1:42388 PELICAN PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403
Practice Address - Country:US
Practice Address - Phone:985-542-6251
Practice Address - Fax:985-345-2386
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA000046207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1074021Medicaid
LA1074021Medicaid