Provider Demographics
NPI:1073530036
Name:KIEL, ERNEST ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:ANTHONY
Last Name:KIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 KINGS HWY
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS, SECTION OF CARDIOLOGY
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4228
Mailing Address - Country:US
Mailing Address - Phone:318-675-8601
Mailing Address - Fax:318-675-8872
Practice Address - Street 1:1501 KINGS HWY
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS, SECTION OF CARDIOLOGY
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:318-675-8601
Practice Address - Fax:318-675-8872
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA11238R2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1906972Medicaid
LA5W131F600OtherMEDICARE - PTAN
LA5W131F600OtherMEDICARE - PTAN