Provider Demographics
NPI:1407887441
Name:COREIL, EDWARD KEMP (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:KEMP
Last Name:COREIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KEMP
Other - Middle Name:
Other - Last Name:COREIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:105 PATRIOT ST STE 202
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6831
Mailing Address - Country:US
Mailing Address - Phone:337-504-7979
Mailing Address - Fax:337-534-0252
Practice Address - Street 1:105 PATRIOT ST STE 202
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6831
Practice Address - Country:US
Practice Address - Phone:337-504-7979
Practice Address - Fax:337-534-0252
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.12561R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5A608CJ92Medicare PIN