MEDICARE: MR. DENIS KAMBEROV MD

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	207R00000X	Internal Medicine Physician	L12090R	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110190542	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	G56567	OTHER	STERLING OPTION 1
4	721417526KA	OTHER	OCHSNERS

General Provider Information

NPI Number	:	1932188422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DENIS KAMBEROV MD

Provider Business Mailing Address
First Line	:	207 JEFFERSON ST
Second Line	:
City	:	MANSFIELD
State	:	LA
Zip	:	71052-2603
Country	:	US
Telephone Number	:	318-872-2700
Fax Number	:	318-872-6214

Provider Business Practice Location Address
First Line	:	130 JEFFERSON STREET
Second Line	:
City	:	MANSFIELD
State	:	LA
Zip	:	71052
Country	:	US
Telephone Number	:	318-872-2700
Fax Number	:	318-872-6214

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	05/04/2020

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