Provider Demographics
NPI:1528459260
Name:LOUISIANA SURGEONS OF EXCELLENCE, LLC
Entity type:Organization
Organization Name:LOUISIANA SURGEONS OF EXCELLENCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIAZY
Authorized Official - Middle Name:MAHMOUD MOHAMED
Authorized Official - Last Name:SELIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-502-8706
Mailing Address - Street 1:215 W PRIEN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8450
Mailing Address - Country:US
Mailing Address - Phone:337-502-8706
Mailing Address - Fax:337-210-1271
Practice Address - Street 1:215 W PRIEN LAKE RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8450
Practice Address - Country:US
Practice Address - Phone:337-502-8706
Practice Address - Fax:337-210-1271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207592208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty