Individual
KENNETH JOHN MEKELBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2525 VIKING DRIVE, BOSSIER CITY, LA 71111-2103
(318) 841-2525
(318) 681-6812
Mailing address
2525 VIKING DRIVE, BOSSIER CITY, LA 71111-2103
(318) 841-2525
(318) 681-6812
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
13801R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1436836
—
LA
Enumeration date
07/08/2005
Last updated
03/29/2012
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