Provider Demographics
NPI:1750341939
Name:WILD, KATHRYN G (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:G
Last Name:WILD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4315 HOUMA BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2940
Mailing Address - Country:US
Mailing Address - Phone:504-885-8563
Mailing Address - Fax:504-455-1072
Practice Address - Street 1:4315 HOUMA BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2940
Practice Address - Country:US
Practice Address - Phone:504-885-8563
Practice Address - Fax:504-455-1072
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA022400207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1493414Medicaid
LA1493414Medicaid
G74300Medicare UPIN