Provider Demographics
NPI:1528046315
Name:AUSEF, AMIR HABIBOLLAH (MD)
Entity type:Individual
Prefix:
First Name:AMIR
Middle Name:HABIBOLLAH
Last Name:AUSEF
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:PO BOX 261164
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70826-1164
Mailing Address - Country:US
Mailing Address - Phone:225-387-7070
Mailing Address - Fax:225-387-7700
Practice Address - Street 1:3600 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3842
Practice Address - Country:US
Practice Address - Phone:225-387-7070
Practice Address - Fax:225-387-7700
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200558207R00000X
TXU5917207R00000X
ARE-16891207R00000X
LAMD.200558208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00310461OtherRAILROAD
LA1722006Medicaid
LA1528046315OtherNPI
LA1528046315OtherNPI
LAP00310461OtherRAILROAD