Individual
KEVIN MARK SITTIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1541 KINGS HWY DEPT OF, SHREVEPORT, LA 71103-4228
(318) 813-2655
(318) 675-4689
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 626-0287
(318) 629-4808
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
017190
LA
2086S0102X
Surgical Critical Care Physician
017190
LA
2086S0120X
Pediatric Surgery Physician
Primary
017190
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386138
—
LA
01
—
55714F600
MEDICARE - PTAN
LA
Enumeration date
07/21/2006
Last updated
08/26/2020
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