Provider Demographics
NPI:1053352328
Name:MARAN, ANTTI G (MD)
Entity type:Individual
Prefix:DR
First Name:ANTTI
Middle Name:G
Last Name:MARAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:411 CALYPSO STREET;
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201
Mailing Address - Country:US
Mailing Address - Phone:318-966-6500
Mailing Address - Fax:318-966-6501
Practice Address - Street 1:411 CALYPSO STREET;
Practice Address - Street 2:SUITE 210
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-966-6500
Practice Address - Fax:318-966-6501
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04712R207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1301469Medicaid
B61762Medicare UPIN
5M313Medicare ID - Type Unspecified