Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 09411R | LA |
Y | 111NI0900X | Internist | 09411R | LA |
N | 207RH0002X | Hospice and Palliative Medicine | 09411R | LA |
NPI | 1093716920 |
---|---|
Provider Name | Dr. Mark Lewis Kantrow |
First Address | Baton Rouge, LA 70816-6038 |
Second Address | Baton Rouge, LA 70809-3738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 31/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00621757 | (05) | MS |
1962783 | (05) | LA |
F81160 | (02) | LA |
P00020218 | RAIL ROAD MEDICARE (01) | LA |