Provider Demographics
NPI:1699778597
Name:SUKEREK, HUSAM HAIDAR (MD)
Entity type:Individual
Prefix:MR
First Name:HUSAM
Middle Name:HAIDAR
Last Name:SUKEREK
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 1:210 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MANY
Mailing Address - State:LA
Mailing Address - Zip Code:71449-3718
Mailing Address - Country:US
Mailing Address - Phone:318-256-5722
Mailing Address - Fax:318-256-5774
Practice Address - Street 1:210 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449-3718
Practice Address - Country:US
Practice Address - Phone:318-256-5722
Practice Address - Fax:318-256-5774
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13676R208000000X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA13676ROtherMEDICAL LISCENSE
LA1436542Medicaid
LAB57334383OtherDEA
LA1436542Medicaid