Provider Demographics
NPI:1487166815
Name:KAREN CARMILLE DANTIN MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:KAREN CARMILLE DANTIN MEDICAL CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DANTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-218-0159
Mailing Address - Street 1:15049 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70819-2602
Mailing Address - Country:US
Mailing Address - Phone:225-218-0159
Mailing Address - Fax:225-218-1233
Practice Address - Street 1:15049 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70819-2602
Practice Address - Country:US
Practice Address - Phone:225-218-0159
Practice Address - Fax:225-218-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017815207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty