Provider Demographics
NPI:1326063553
Name:MCGANN, KEVIN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MARK
Last Name:MCGANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7607 FERN AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5699
Mailing Address - Country:US
Mailing Address - Phone:318-393-5980
Mailing Address - Fax:318-683-5182
Practice Address - Street 1:9425 HEALTHPLEX DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-8148
Practice Address - Country:US
Practice Address - Phone:318-683-5171
Practice Address - Fax:318-683-5182
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2020-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA026369207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1562939Medicaid
LA4K328CD73OtherMEDICARE GROUP ID
LAI65487Medicare UPIN
LA1562939Medicaid