Leon A Cannizzaro Iii (NPI# 1356585228, PAC ID# 2365759867) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is CARDIOVASCULAR DISEASE (CARDIOLOGY).
| Nation Provider ID (NPI) | 1356585228 |
| PAC ID by PECOS | 2365759867 |
| Professional Enrollment ID | I20150916001003 |
| Full Name | Leon A Cannizzaro Iii |
| Organization Legal Name | OUR LADY OF THE LAKE PHYSICIAN GROUP LLC |
| Address |
34870 La Hwy 1019 Denham Springs LA 70706-0659 |
| Phone Number | 2252436450 |
| Gender | M |
| Graduation Year | 2009 |
| Primary Specialty | CARDIOVASCULAR DISEASE (CARDIOLOGY) |
| Secondary Specialties | INTERNAL MEDICINE |
| Group Practice PAC ID | 4587849781 |
| Number of Group Practice Members | 474 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 190064 | OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER |
| 190065 | BATON ROUGE GENERAL MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 6516 E Myrtle Ave, Baker, LA 70714-4348 | 2257747320 | OUR LADY OF THE LAKE PHYSICIAN GROUP LLC |
| 6516 E Myrtle Ave, Louisiana Cardiology Associates, Baker, LA 70714-4348 | 2257673900 | OUR LADY OF THE LAKE PHYSICIAN GROUP LLC |
| 1401 N Foster Dr, Lsu Health Urgent Care Clinic, Baton Rouge, LA 70806-1818 | 2253581063 | OUR LADY OF THE LAKE PHYSICIAN GROUP LLC |
| 5000 Hennessy Blvd, Baton Rouge, LA 70808-4375 | OUR LADY OF THE LAKE PHYSICIAN GROUP LLC | |
| 5000 Hennessy Blvd, Suite 3, Baton Rouge, LA 70808-4375 | 2257658987 | OUR LADY OF THE LAKE PHYSICIAN GROUP LLC |
| 5439 Airline Hwy, Baton Rouge, LA 70805-1712 | 2253584853 | OUR LADY OF THE LAKE PHYSICIAN GROUP LLC |
| 7777 Hennessy Blvd, Baton Rouge, LA 70808-4363 | OUR LADY OF THE LAKE PHYSICIAN GROUP LLC | |
| 34870 La Hwy 1019, Denham Springs, LA 70706-0659 | 2252436450 | OUR LADY OF THE LAKE PHYSICIAN GROUP LLC |
| 2647 S Saint Elizabeth Blvd, Gonzales, LA 70737-5017 | OUR LADY OF THE LAKE PHYSICIAN GROUP LLC | |
| 59315 River W Dr, Suite C, Plaquemine, LA 70764-6553 | 2256876629 | OUR LADY OF THE LAKE PHYSICIAN GROUP LLC |
| 59315 River W Dr C, Plaquemine, LA 70764-6553 | OUR LADY OF THE LAKE PHYSICIAN GROUP LLC | |
| 5000 Odonavan Blvd, Walker, LA 70785-6355 | OUR LADY OF THE LAKE PHYSICIAN GROUP LLC |
| Organization Legal Name | OUR LADY OF THE LAKE PHYSICIAN GROUP LLC |
| Physicians | 443 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| James Michael Robinson | Family Medicine | Our Lady of The Lake Physician Group LLC | 12525 Perkins Rd A, Baton Rouge, LA 70810-1907 |
| Kori Fogg Juban | Nurse Practitioner | Our Lady of The Lake Physician Group LLC | 34870 La Hwy 1019, Denham Springs, LA 70706-0659 |
| Michelle Duhe | Family Medicine | Our Lady of The Lake Physician Group LLC | 26739 La Hwy 1032, Denham Springs, LA 70726-4926 |
| Swapna G Kallu | Internal Medicine | Our Lady of The Lake Physician Group LLC | 214 Clinic Dr, Donaldsonville, LA 70346-4309 |
| Montrell Martin-duhe | Nurse Practitioner | Our Lady of The Lake Physician Group LLC | 4463 La Hwy 1 S A, Port Allen, LA 70767-5990 |
| Joshua R Clark | Family Medicine | Our Lady of The Lake Physician Group LLC | 59315 River W Dr, Suite C, Plaquemine, LA 70764-6553 |
| Hollie B Ortis | Nurse Practitioner | Our Lady of The Lake Physician Group LLC | 13489 Hwy 431, Suite A, Saint Amant, LA 70774-3213 |
| Shantan Ravula | Family Medicine | Our Lady of The Lake Physician Group LLC | 14225 Hwy 73, Prairieville, LA 70769-3616 |
| Daniel Kevin Lavie | Hematology/oncology | Our Lady of The Lake Physician Group LLC | 4950 Essen Ln, Suite 400, Baton Rouge, LA 70809-3738 |
| Sheri A Ammons | Nurse Practitioner | Our Lady of The Lake Physician Group LLC | 5428 Odonovan Dr B, Baton Rouge, LA 70808-4374 |
| Street Address |
34870 LA HWY 1019 |
| City | DENHAM SPRINGS |
| State | LA |
| Zip | 70706-0659 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kori Fogg Juban | Nurse Practitioner | Our Lady of The Lake Physician Group LLC | 34870 La Hwy 1019, Denham Springs, LA 70706-0659 |
| Denzil Louis Moraes | Interventional Cardiology | Our Lady of The Lake Physician Group LLC | 34870 La Hwy 1019, Denham Springs, LA 70706-0659 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Ellis E Johnson Iii | Physical Therapy | 35055 La Hwy 16, Suite 1c, Denham Springs, LA 70706-1535 | |
| Mandy R Erwin | Nurse Practitioner | 35055 La Hwy 16 2h, Denham Springs, LA 70706-1535 | |
| Wayne D Foster Jr. | Nurse Practitioner | 8406 Le Marie Ct, Denham Springs, LA 70706-1536 |
| City | DENHAM SPRINGS |
| Zip Code | 70706 |
| Specialty | CARDIOVASCULAR DISEASE (CARDIOLOGY) |
| City + Specialty | DENHAM SPRINGS + CARDIOVASCULAR DISEASE (CARDIOLOGY) |
Please comment or provide details below to improve the information on Leon A Cannizzaro Iii.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.