MEDICARE: DR. SHANTIPRAKASH M KEDIA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	05114R	LA

General Provider Information

NPI Number	:	1295738557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANTIPRAKASH M KEDIA M.D.

Provider Business Mailing Address
First Line	:	1111 MEDICAL CENTER BLVD
Second Line	:	STE S450
City	:	MARRERO
State	:	LA
Zip	:	70072-3151
Country	:	US
Telephone Number	:	504-349-6423
Fax Number	:	504-349-6062

Provider Business Practice Location Address
First Line	:	1111 MEDICAL CENTER BLVD
Second Line	:	STE S450
City	:	MARRERO
State	:	LA
Zip	:	70072-3151
Country	:	US
Telephone Number	:	504-349-6401
Fax Number	:	504-349-6444

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	11/14/2013

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