Provider Demographics
NPI:1659364495
Name:JOSEPH, KEVIN O (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:O
Last Name:JOSEPH
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 1:2900 INDIANA AVENUE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-4605
Mailing Address - Country:US
Mailing Address - Phone:985-307-1600
Mailing Address - Fax:504-575-3691
Practice Address - Street 1:843 MILLING AVE
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-4442
Practice Address - Country:US
Practice Address - Phone:985-785-5800
Practice Address - Fax:985-785-5811
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1579483Medicaid
LA1486965Medicaid
LA5H671DJ03Medicare PIN
LA191834Medicare PIN
LA191866Medicare PIN
LA5H671CY49Medicare PIN
LA1486965Medicaid
LA5H671CD42Medicare PIN
LA191851Medicare PIN
LA191865Medicare PIN