Healthcare Provider Details

I. General information

NPI: 1518349919
Provider Name (Legal Business Name): BADER KFOURY M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date: 02/02/2016
Reactivation Date: 03/07/2016

III. Provider practice location address

4809 AMBASSADOR CAFFERY PKWY STE 460
LAFAYETTE LA
70508-8800
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-6438
  • Fax: 337-470-0080
Mailing address:
  • Phone: 337-470-6438
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number244202
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT216942
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number324281
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: