Provider Demographics
NPI:1760474191
Name:LEBLANC, KIRK STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:STEVEN
Last Name:LEBLANC
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 1:1000 W PINHOOK RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2460
Mailing Address - Country:US
Mailing Address - Phone:337-234-8533
Mailing Address - Fax:337-234-8534
Practice Address - Street 1:1000 W PINHOOK RD
Practice Address - Street 2:SUITE 303
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2460
Practice Address - Country:US
Practice Address - Phone:337-234-8533
Practice Address - Fax:337-234-8534
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09274R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1668681Medicaid
LA1441805Medicaid
LAF50786Medicare UPIN
LA5W493Medicare ID - Type UnspecifiedINDIVIDUAL
LA1668681Medicaid
LA4438530002Medicare NSC
LA5C925Medicare ID - Type UnspecifiedGROUP NUMBER