Healthcare Provider Details

I. General information

NPI: 1093855132
Provider Name (Legal Business Name): AMIT KUMAR KSHETARPAL M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2117 VETERANS MEMORIAL BLVD STE 248
METAIRIE LA
70002-6321
US

IV. Provider business mailing address

2117 VETERANS MEMORIAL BLVD 248
METAIRIE LA
70002-6321
US

V. Phone/Fax

Practice location:
  • Phone: 727-834-3959
  • Fax:
Mailing address:
  • Phone: 281-749-8230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number14829
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number14829
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: