Provider Demographics
NPI:1699778118
Name:HATIPOGLU, MUSTAFA (MD)
Entity type:Individual
Prefix:DR
First Name:MUSTAFA
Middle Name:
Last Name:HATIPOGLU
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 1:4424 CONLIN ST
Mailing Address - Street 2:STE 2B
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2147
Mailing Address - Country:US
Mailing Address - Phone:504-888-8717
Mailing Address - Fax:504-888-8730
Practice Address - Street 1:4020 PARIS RD
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-1362
Practice Address - Country:US
Practice Address - Phone:504-277-8423
Practice Address - Fax:504-888-8730
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03798R207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA210915OtherCOVENTRY
LA1146668Medicaid
LA4028228OtherAETNA
LA496645410OtherBLUE CROSS OF LA.
LA1146668Medicaid
LA496645410OtherBLUE CROSS OF LA.