Provider Demographics
NPI:1629069836
Name:THALY, KAMALAKANT GOVIND (MD)
Entity Type:Individual
Prefix:
First Name:KAMALAKANT
Middle Name:GOVIND
Last Name:THALY
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:151 MEADOWCREST ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056
Mailing Address - Country:US
Mailing Address - Phone:504-392-9298
Mailing Address - Fax:504-392-7047
Practice Address - Street 1:151 MEADOWCREST ST
Practice Address - Street 2:SUITE F
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056
Practice Address - Country:US
Practice Address - Phone:504-392-9298
Practice Address - Fax:504-392-7047
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA014513208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1312606Medicaid