Provider Demographics
NPI:1306943857
Name:QURESHI, IRUM ALISIA (MD)
Entity type:Individual
Prefix:
First Name:IRUM
Middle Name:ALISIA
Last Name:QURESHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 DANNY PARK
Mailing Address - Street 2:SUITE 100
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5776
Mailing Address - Country:US
Mailing Address - Phone:504-889-0550
Mailing Address - Fax:504-889-0582
Practice Address - Street 1:3225 DANNY PARK
Practice Address - Street 2:SUITE 100
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5776
Practice Address - Country:US
Practice Address - Phone:504-889-0550
Practice Address - Fax:504-889-0582
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD200143174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1049221Medicaid
LA1049221Medicaid
LA4K384C771Medicare PIN
LA4K384C773Medicare PIN