Mekelburg, Kenneth John

Mekelburg, Kenneth John is an individual health care provider with primary practice located at 2525 Viking Drive , Bossier City LA 71111-2103. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Mekelburg, Kenneth John can be contacted via phone (318) 841-2525.

Contact Information

Primary practice address
2525 Viking Drive Bossier City LA 71111-2103
Fax: (318) 681-6812
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 13801R Louisiana

Profile Details

NPI number 1619975166
LBN Legal business name Mekelburg, Kenneth John
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 8th, 2005
Last updated Mar 29th, 2012 - about 13 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 1619975166 NPPES
Louisiana MEDICAID 1436836

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