Doctor Name: | DR. BRIJ M MITRUKA |
NPI Number: | 1831300052 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | MD.11354R |
Business Practice Address: | 3501 Holiday Dr Suite 204 New Orleans, LA - 701148202 |
Business Phone Number: | 5042630680 |
Business Fax Number: | 5042630887 |
Mailing Address: | 2829 Eton St, NEW ORLEANS |
State: | LA |
Postal Code: | 701313803 |
Phone Number: | 5042630680 |
Fax Number: | 5042630887 |
NPI Enumeration Date: | 05/28/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | MD.11354R |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |