Provider Demographics
NPI:1851359244
Name:KIOK, MAXIMO C (MD)
Entity Type:Individual
Prefix:
First Name:MAXIMO
Middle Name:C
Last Name:KIOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:130 DESIARD ST STE 355
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7363
Mailing Address - Country:US
Mailing Address - Phone:318-998-3426
Mailing Address - Fax:318-812-6603
Practice Address - Street 1:920 OLIVER RD # L
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5702
Practice Address - Country:US
Practice Address - Phone:318-361-2161
Practice Address - Fax:318-812-6055
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND115622084N0400X
LA15200R2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1461113Medicaid
ND715202Medicare PIN
LAC33490Medicare UPIN