Provider Demographics
NPI:1871564559
Name:MOUSTOUKAS, NICK (MD)
Entity type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:MOUSTOUKAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3600 PRYTANIA ST
Mailing Address - Street 2:SUITE 35
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3628
Mailing Address - Country:US
Mailing Address - Phone:504-897-8315
Mailing Address - Fax:504-891-9862
Practice Address - Street 1:3715 PRYTANIA ST
Practice Address - Street 2:STE 400
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3761
Practice Address - Country:US
Practice Address - Phone:504-897-8276
Practice Address - Fax:504-897-8336
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-06-17
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Provider Licenses
StateLicense IDTaxonomies
LA015305208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1355160Medicaid
LA50744D516Medicare PIN
LA1355160Medicaid