MEDICARE: KEITH J. CAPONE, MD, LLC

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	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376949768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEITH J. CAPONE, MD, LLC

Provider Business Mailing Address
First Line	:	6517 SPANISH FORT BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70124-4321
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6517 SPANISH FORT BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70124-4321
Country	:	US
Telephone Number	:	504-283-7306
Fax Number	:	504-283-7308

Authorized Official
Title or Position	:	BOOKKEEPER/MANAGER
Name	:	MRS. BRANDI DOTY
Credential	:
Telephone Number	:	985-626-0855

Provider Enumeration Date	:	11/12/2014
Last Update Date	:	02/17/2017

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