Provider Demographics
NPI:1750497269
Name:AMARANENI, KUMAR KISHORE (MD)
Entity Type:Individual
Prefix:DR
First Name:KUMAR
Middle Name:KISHORE
Last Name:AMARANENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KISHORE
Other - Middle Name:KUMAR
Other - Last Name:AMARANENI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2375 GAUSE BLVD E
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4142
Mailing Address - Country:US
Mailing Address - Phone:985-645-9000
Mailing Address - Fax:985-645-0359
Practice Address - Street 1:2375 GAUSE BLVD E
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4142
Practice Address - Country:US
Practice Address - Phone:985-645-9000
Practice Address - Fax:985-645-0359
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6512R207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1346365Medicaid
LAF8683OtherBCBS
LAB61933Medicare UPIN
LA5M641Medicare PIN
LAF8683OtherBCBS