Healthcare Provider Details

I. General information

NPI: 1750497269
Provider Name (Legal Business Name): KUMAR KISHORE AMARANENI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KISHORE KUMAR AMARANENI MD

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 GAUSE BLVD E
SLIDELL LA
70461-4142
US

IV. Provider business mailing address

2375 GAUSE BLVD E
SLIDELL LA
70461-4142
US

V. Phone/Fax

Practice location:
  • Phone: 985-645-9000
  • Fax: 985-645-0359
Mailing address:
  • Phone: 985-645-9000
  • Fax: 985-645-0359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number6512R
License Number StateLA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1346365
Identifier TypeMEDICAID
Identifier StateLA
Identifier Issuer
# 2
IdentifierF8683
Identifier TypeOTHER
Identifier StateLA
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: