MEDICARE: LOUIS KAVOUSSI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	D44328	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700833985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUIS KAVOUSSI M.D.

Provider Business Mailing Address
First Line	:	450 LAKEVILLE RD
Second Line	:	SUITE M41
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1118
Country	:	US
Telephone Number	:	516-734-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 LAKEVILLE RD
Second Line	:	SUITE M41
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1118
Country	:	US
Telephone Number	:	516-734-8500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	12/12/2013

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