Most Relevant Information
Provider Data
| NPI Number: | 1003558594 |
| Provider Name: | MATTHEW DISEDARE |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/13/2022 |
| Last Updated: | 04/13/2022 |
Provider Practice Location
1418 TIGER DR
THIBODAUX
LA
703014337
Practice Location Phone/Fax
| Phone: | 9854494055 |
| Fax: | 9854494178 |
Provider Mailing Location
1418 TIGER DR
THIBODAUX
LA
703014337
Provider Mailing Phone/Fax
| Phone: | 9854494055 |
| Fax: | 9854494178 |