Provider Demographics
NPI:1093855132
Name:KSHETARPAL, AMIT KUMAR (MD,)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:KUMAR
Last Name:KSHETARPAL
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 1:2117 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:248
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-6321
Mailing Address - Country:US
Mailing Address - Phone:281-749-8230
Mailing Address - Fax:
Practice Address - Street 1:2117 VETERANS MEMORIAL BLVD
Practice Address - Street 2:STE 248
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6321
Practice Address - Country:US
Practice Address - Phone:727-834-3959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA148292084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B60766Medicare UPIN
5K1790123Medicare ID - Type Unspecified