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General NPI Number Information
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NPI Number | 1932490554
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Entity Type | Individual
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Provider Name | MICHAEL THOMAS KITCHELL MD
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Gender | Male
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Dates
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Enumeration Date | 04/30/2011
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 8383 MILLICENT WAY
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City | SHREVEPORT
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State | LA
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Zip | 71115-5207
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Country | US
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Telephone | 318-797-6661
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Fax | 318-795-8512
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Provider Business Mailing Address
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Address Line | 1666 E BERT KOUN LOOP STE 105
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City | SHREVEPORT
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State | LA
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Zip | 71105-5718
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Country | US
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Telephone | 318-212-3520
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Fax | 318-212-3525
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD.206535
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License Number State | LA
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