Basic Information
| Provider Information | |||||||||
| NPI: | 1770548349 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IMSAIS | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | K. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1542 TULANE AVE | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701122865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043103704 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 CANAL ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701123018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5047023000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 07/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | M7290 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD026039 | LA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | MD026039 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 190193616 | 05 | TX | MEDICAID | 190193617 | 01 | TX | CSHCN | OTHER | 1055310 | 05 | LA | MEDICAID | G6438 | 01 | LA | BCBS | OTHER |