Provider Demographics
NPI:1942245345
Name:BILDERBACK, KARL K (MD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:K
Last Name:BILDERBACK
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 1:7925 YOUREE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5538
Mailing Address - Country:US
Mailing Address - Phone:318-798-6700
Mailing Address - Fax:318-212-3677
Practice Address - Street 1:7925 YOUREE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5538
Practice Address - Country:US
Practice Address - Phone:318-798-6700
Practice Address - Fax:318-798-6799
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09187R207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1950459Medicaid
LA5R164Medicare PIN
LA1950459Medicaid
LA5R164CR96Medicare PIN