Individual
KIPP BURNETTE ARDOIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2903 1ST AVE, LAKE CHARLES, LA 70601-8809
(337) 478-6480
Mailing address
2903 1ST AVE, LAKE CHARLES, LA 70601-8809
(337) 478-6480
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
GETP.TUL.PED
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002992
—
LA
Enumeration date
11/14/2007
Last updated
04/18/2013
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