Healthcare Provider Details

I. General information

NPI: 1851359244
Provider Name (Legal Business Name): MAXIMO C KIOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 OLIVER RD # L
MONROE LA
71201-5702
US

IV. Provider business mailing address

130 DESIARD ST STE 355
MONROE LA
71201-7363
US

V. Phone/Fax

Practice location:
  • Phone: 318-361-2161
  • Fax: 318-812-6055
Mailing address:
  • Phone: 318-998-3426
  • Fax: 318-812-6603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number11562
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number15200R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: