Provider Demographics
NPI:1508084005
Name:KINDL, BRIAN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:THOMAS
Last Name:KINDL
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 1:1570 LINDBERG DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-8083
Mailing Address - Country:US
Mailing Address - Phone:985-326-8614
Mailing Address - Fax:
Practice Address - Street 1:1810 LINDBERG DR STE 1400
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8064
Practice Address - Country:US
Practice Address - Phone:985-326-8614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241612207X00000X
MS24514207X00000X, 207XX0005X
FLME114694207XX0005X
LAMD-202539207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1508084005OtherNPI
LA1055492Medicaid
MS01154595Medicaid
MS01154595Medicaid
LA4N991Medicare PIN
LA1508084005OtherNPI
LA4N9916629Medicare PIN