Provider Demographics
NPI:1073539862
Name:KINZIE, ERIK L (MD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:L
Last Name:KINZIE
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 1:5131 ODONOVAN DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4782
Mailing Address - Country:US
Mailing Address - Phone:225-374-0400
Mailing Address - Fax:225-374-0430
Practice Address - Street 1:5131 ODONOVAN DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4782
Practice Address - Country:US
Practice Address - Phone:225-374-0400
Practice Address - Fax:225-374-0430
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2017692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1031534Medicaid
LAI33124Medicare UPIN
LA1031534Medicaid