Doctor Name: | KENNY KALUBABARI MSIAKII |
NPI Number: | 1821115932 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | COC0700223 |
Business Practice Address: | 610 Marshall St Suite #501 Shreveport, LA - 711013784 |
Business Phone Number: | 3182226656 |
Business Fax Number: | 3182226656 |
Mailing Address: | 610 Marshall St, Suite #501 SHREVEPORT |
State: | LA |
Postal Code: | 711013784 |
Phone Number: | 3182226656 |
Fax Number: | 3182226656 |
NPI Enumeration Date: | 03/23/2007 |
NPI Last Update Date: | 11/29/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | COC0700223 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |