Organization
KENNETH MEKELBURG MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH JOHN MEKELBURG MD (MD/OWNER)
(318) 425-4096
Entity
Organization
Contact information
Practice address
2525 VIKING DRIVE, BOSSIER CITY, LA 71111-2103
(318) 425-4096
(318) 681-6812
Mailing address
PO BOX 1684, SHREVEPORT, LA 71165-1684
(318) 425-4096
(318) 681-6812
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
13801R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1436836
—
LA
Enumeration date
06/16/2008
Last updated
01/10/2012
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