Provider Demographics
NPI:1447305768
Name:AMUSA, KWELI JOHARI (MD)
Entity type:Individual
Prefix:
First Name:KWELI
Middle Name:JOHARI
Last Name:AMUSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:2735 HIGHWAY 190
Practice Address - Street 2:SUITE D
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3433
Practice Address - Country:US
Practice Address - Phone:985-778-2510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10977207R00000X
LAMD.06700R207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126584Medicaid
MSP00808485OtherRAILROAD MEDICARE PTAN
LA1352136Medicaid
MS4274592OtherAETNA
LA335699YH3UMedicare PIN
LA1352136Medicaid
MS00126584Medicaid
MS512I110122Medicare PIN
MS4274592OtherAETNA