Provider Demographics
NPI:1932197886
Name:KOMPELLI, ASHOK R (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHOK
Middle Name:R
Last Name:KOMPELLI
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 1:2751 ALBERT BICKNELL DRIVE
Mailing Address - Street 2:SUITE 2-C
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103
Mailing Address - Country:US
Mailing Address - Phone:318-631-9190
Mailing Address - Fax:318-631-9198
Practice Address - Street 1:2751 ALBERT BICKNELL DRIVE
Practice Address - Street 2:SUITE 2-C
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103
Practice Address - Country:US
Practice Address - Phone:318-631-9190
Practice Address - Fax:318-631-9198
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA28049207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1487031Medicaid
LAH23119Medicare UPIN
LA1487031Medicaid