Healthcare Provider Details

I. General information

NPI: 1285672303
Provider Name (Legal Business Name): KEVIN A COURVILLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8644 EUNICE IOTA HWY
EUNICE LA
70535-6749
US

IV. Provider business mailing address

PO BOX 80567
LAFAYETTE LA
70598-0567
US

V. Phone/Fax

Practice location:
  • Phone: 337-466-7474
  • Fax: 337-466-7575
Mailing address:
  • Phone: 337-466-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD.026644
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberMD.026644
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: