Healthcare Provider Details

I. General information

NPI: 1699582247
Provider Name (Legal Business Name): BHARATH RAJ KIDAMBI MBBS MD DM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date: 09/19/2025
Reactivation Date: 10/27/2025

III. Provider practice location address

422 KADE ST STE 1
JENNINGS LA
70546-3657
US

IV. Provider business mailing address

422 KADE ST STE 1
JENNINGS LA
70546-3657
US

V. Phone/Fax

Practice location:
  • Phone: 337-388-6200
  • Fax: 337-388-6201
Mailing address:
  • Phone: 337-388-6200
  • Fax: 337-388-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number353995
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: