MEDICARE: DR. KUMAR KISHORE AMARANENI MD

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	6512R	LA

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
2	F8683	OTHER	LA	BCBS

General Provider Information

NPI Number	:	1750497269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KUMAR KISHORE AMARANENI MD

Provider Business Mailing Address
First Line	:	2375 GAUSE BLVD E
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70461-4142
Country	:	US
Telephone Number	:	985-645-9000
Fax Number	:	985-645-0359

Provider Business Practice Location Address
First Line	:	2375 GAUSE BLVD E
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70461-4142
Country	:	US
Telephone Number	:	985-645-9000
Fax Number	:	985-645-0359

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	09/22/2010

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