Provider Demographics
NPI:1033101159
Name:KJELLGREN, OLLE (MD)
Entity Type:Individual
Prefix:
First Name:OLLE
Middle Name:
Last Name:KJELLGREN
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 1:2633 NAPOLEON AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6357
Mailing Address - Country:US
Mailing Address - Phone:504-897-9686
Mailing Address - Fax:
Practice Address - Street 1:2633 NAPOLEON AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6357
Practice Address - Country:US
Practice Address - Phone:504-897-9686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11239R207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03603593Medicaid
LA1665398Medicaid
LA5W267B953Medicare PIN
LA5W267Medicare PIN
LA060031134Medicare PIN
LA437279YH3UMedicare PIN
MS03603593Medicaid