1740323823 NPI number — JANARDANA P. KAIMAL, MD, LLC

Table of content: (NPI 1740323823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740323823 NPI number — JANARDANA P. KAIMAL, MD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JANARDANA P. KAIMAL, MD, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740323823
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4591
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE CHARLES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70606-4591
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-436-7560
Provider Business Mailing Address Fax Number:
337-433-9861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4820 LAKE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70605-6010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-310-7378
Provider Business Practice Location Address Fax Number:
337-310-7382
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KAIMAL
Authorized Official First Name:
JANARDANA
Authorized Official Middle Name:
PARAMESWARA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
337-310-7278

Provider Taxonomy Codes

  • Taxonomy code: 207RS0012X , with the licence number:  3828R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1179329 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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