| Organization Name: | PELICAN STATE INDUSTRIAL MEDICINE |
| NPI Number: | 1679527725 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL D. KOTLER (OWNER) |
| Mailing Address: | 1525 Dickory Ave Harahan |
| State: | LA US |
| Postal Code: | 701232168 |
| Phone Number: | 5048180006 |
| Fax Number: | |
| NPI Enumeration Date: | 05/22/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |