Provider Demographics
NPI:1912117250
Name:KLEINPETER, KENNETH PHILLIP JR (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:PHILLIP
Last Name:KLEINPETER
Suffix:JR
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 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 612
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-769-5656
Mailing Address - Fax:225-766-6996
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 612
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-769-5656
Practice Address - Fax:225-766-6996
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201383208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1012530Medicaid
LA3A392CR65Medicare PIN