Kavanaugh, Mindie Michelle

Kavanaugh, Mindie Michelle is an individual health care provider with primary practice located at 1501 Kings Hwy Department Of Internal Medicine, Shreveport LA 71103-4228. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Hematology & Oncology. Allopathic & Osteopathic Physicians / Hematology & Oncology is her primary health care specialty. Kavanaugh, Mindie Michelle can be contacted via phone (318) 813-1431.

Contact Information

Primary practice address
1501 Kings Hwy Department Of Internal Medicine Shreveport LA 71103-4228
Phone: (318) 813-1431
Fax: (318) 813-1444
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 203912 Louisiana
Allopathic & Osteopathic Physicians / Hematology & Oncology 207RH0003X 203912 Louisiana

Profile Details

NPI number 1487897922
LBN Legal business name Kavanaugh, Mindie Michelle
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 14th, 2009
Last updated Apr 29th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487897922 NPPES
Louisiana Other 39108YH54 MEDICARE - PTAN
Louisiana MEDICAID 19933147 MEDICARE - PTAN

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