Individual
MARIO KAKAZU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2552 WILLIAMS BLVD, KENNER, LA 70062-5538
(504) 463-3002
Mailing address
PO BOX 2490, MARRERO, LA 70073-2490
(504) 762-8909
(504) 328-0899
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
05311R
LA
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD.05311R
LA
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1317128
—
LA
01
—
G6438
BLUECROSS BLUESHIELD
LA
Enumeration date
01/16/2006
Last updated
06/30/2021
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