Provider Demographics
NPI:1003979873
Name:GADDE, KISHORE M (MD)
Entity Type:Individual
Prefix:
First Name:KISHORE
Middle Name:M
Last Name:GADDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4124
Mailing Address - Country:US
Mailing Address - Phone:225-763-2552
Mailing Address - Fax:
Practice Address - Street 1:6400 PERKINS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808
Practice Address - Country:US
Practice Address - Phone:225-763-2552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.2074772084B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0002XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2195454Medicare ID - Type Unspecified
F20026Medicare ID - Type Unspecified
NC8934188Medicare ID - Type Unspecified