Provider Demographics
NPI:1356370688
Name:JANI, KAMLESH (MD)
Entity type:Individual
Prefix:
First Name:KAMLESH
Middle Name:
Last Name:JANI
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 1:8001 YOUREE DR STE 720
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2336
Mailing Address - Country:US
Mailing Address - Phone:318-212-3681
Mailing Address - Fax:318-212-3687
Practice Address - Street 1:8001 YOUREE DR STE 720
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2336
Practice Address - Country:US
Practice Address - Phone:318-212-3681
Practice Address - Fax:318-212-3687
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11929R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1536971Medicaid
LA1536971Medicaid
LA4E946CP07Medicare PIN