Provider Demographics
NPI:1245229459
Name:CALLERAME, KEVIN J (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:CALLERAME
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2051 SILVERSIDE DR
Mailing Address - Street 2:STE 260
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9005
Mailing Address - Country:US
Mailing Address - Phone:225-490-6301
Mailing Address - Fax:225-765-9539
Practice Address - Street 1:5427 DIDESSE DRIVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808
Practice Address - Country:US
Practice Address - Phone:225-215-2193
Practice Address - Fax:225-215-2194
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2021-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA0209602084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1114359Medicaid
LA393610YJA2Medicare PIN
LAG04035Medicare UPIN
LA4E0257545Medicare PIN