Provider Demographics
NPI:1235174434
Name:QUICK, KENNETH (DPM)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:QUICK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 ST ANN DR
Mailing Address - Street 2:STE 4
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3395
Mailing Address - Country:US
Mailing Address - Phone:985-727-3936
Mailing Address - Fax:985-727-3525
Practice Address - Street 1:233 ST ANN DR
Practice Address - Street 2:SUITE 4
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3395
Practice Address - Country:US
Practice Address - Phone:985-727-3936
Practice Address - Fax:985-727-3525
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD117R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1925560Medicaid
LAU17420Medicare UPIN
LA5N917BC01Medicare PIN
LA5N917Medicare ID - Type Unspecified