Provider Demographics
NPI:1932112034
Name:CONTREARY, KELVIN JOHN (MD)
Entity Type:Individual
Prefix:
First Name:KELVIN
Middle Name:JOHN
Last Name:CONTREARY
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 1:4224 HOUMA BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2910
Mailing Address - Country:US
Mailing Address - Phone:504-454-6338
Mailing Address - Fax:504-456-8016
Practice Address - Street 1:4224 HOUMA BLVD STE 310
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2910
Practice Address - Country:US
Practice Address - Phone:504-454-6338
Practice Address - Fax:504-456-8016
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014405174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1317144Medicaid
LA5K107B447Medicare ID - Type Unspecified
LAB60730Medicare UPIN