Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 11239R | LA |
NPI | 1033101159 |
---|---|
Provider Name | Olle Kjellgren |
First Address | New Orleans, LA 70115-6357 |
Second Address | New Orleans, LA 70115-6357 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 17/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03603593 | (05) | MS |
1665398 | (05) | LA |
G07811 | (02) | LA |