Provider Demographics
NPI:1972526986
Name:HAPPEL, KYLE ITTMANN (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ITTMANN
Last Name:HAPPEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1340 POYDRAS ST
Mailing Address - Street 2:SUITE 1640
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1221
Mailing Address - Country:US
Mailing Address - Phone:504-412-1835
Mailing Address - Fax:
Practice Address - Street 1:200 W ESPLANADE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2489
Practice Address - Country:US
Practice Address - Phone:504-412-1705
Practice Address - Fax:504-412-1702
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA13482R207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02928221Medicaid
LA1421006Medicaid
LA1421006Medicaid
LAP00033533Medicare PIN
H24531Medicare UPIN
MS02928221Medicaid
LA5H7657061Medicare PIN