Provider Demographics
NPI:1689667198
Name:MATHEW, KARIPPELIL E (MD)
Entity Type:Individual
Prefix:
First Name:KARIPPELIL
Middle Name:E
Last Name:MATHEW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 E HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4715
Mailing Address - Country:US
Mailing Address - Phone:225-644-7337
Mailing Address - Fax:225-644-5202
Practice Address - Street 1:721 E HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4715
Practice Address - Country:US
Practice Address - Phone:225-644-7337
Practice Address - Fax:225-644-5202
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04796R208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
5M200Medicare ID - Type Unspecified
B61708Medicare UPIN