Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 017190 | LA |
N | 208600000X | Surgeon | 017190 | LA |
N | 2086S0102X | Surgical Critical Care | 017190 | LA |
Y | 2086S0120X | Pediatric Surgery | 017190 | LA |
NPI | 1104846989 |
---|---|
Provider Name | Kevin Mark Sittig |
First Address | Shreveport, LA 71103-3822 |
Second Address | Shreveport, LA 71103-4228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 26/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1386138 | (05) | LA |
55714F600 | MEDICARE - PTAN (01) | LA |
D87053 | (02) | LA |