MEDICARE: DR. KENNETH J CAPONE 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	208000000X	Pediatrics Physician	014719	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

General Provider Information

NPI Number	:	1871504290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH J CAPONE M.D.

Provider Business Mailing Address
First Line	:	201 SAINT ANN DR
Second Line	:	SUITE B
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3219
Country	:	US
Telephone Number	:	985-626-1717
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 SAINT ANN DR
Second Line	:	SUITE B
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3219
Country	:	US
Telephone Number	:	985-626-1717
Fax Number	:

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	04/01/2011

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