Provider Demographics
NPI:1689687782
Name:DUPKE, KEVIN C (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:DUPKE
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 1:160 CALCASIEU DR
Mailing Address - Street 2:
Mailing Address - City:CREOLE
Mailing Address - State:LA
Mailing Address - Zip Code:70632-3112
Mailing Address - Country:US
Mailing Address - Phone:337-321-1680
Mailing Address - Fax:337-542-4015
Practice Address - Street 1:160 CALCASIEU DR
Practice Address - Street 2:
Practice Address - City:CREOLE
Practice Address - State:LA
Practice Address - Zip Code:70632
Practice Address - Country:US
Practice Address - Phone:337-321-1680
Practice Address - Fax:337-542-4015
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12043R207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009933678Medicaid
MSP00263508OtherRAILROAD MEDICARE
MS03974517Medicaid
AL009933678Medicaid
MS060000846Medicare ID - Type Unspecified