Healthcare Provider Details

I. General information

NPI: 1942282389
Provider Name (Legal Business Name): KENNETH ODINET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BEAULLIEU DR BUILDING 6
LAFAYETTE LA
70508-7230
US

IV. Provider business mailing address

200 BEAULLIEU DR BUILDING 6
LAFAYETTE LA
70508-7230
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-8648
  • Fax: 337-233-0244
Mailing address:
  • Phone: 337-234-8648
  • Fax: 337-233-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD019937
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD019937
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: