Individual
DR. KENNETH CHARLES CIVELLO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MPH
Contact information
Practice address
7777 HENNESSY BLVD, SUITE 1000, BATON ROUGE, LA 70808-4300
(225) 767-3900
(225) 766-2226
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(222) 526-0001
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
201354
LA
207RC0000X
Cardiovascular Disease Physician
35084798
OH
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
201354
LA
207RC0001X
Clinical Cardiac Electrophysiology Physician
35084798
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000364128
ANTHEM
OH
01
—
1006122
QUAL
OH
05
—
1108910
—
LA
01
—
114845
KAISER
OH
05
—
2515157
—
OH
01
—
E84798
SUMMA
OH
01
—
P00225594
RAILROAD MEDICARE
—
Enumeration date
01/24/2006
Last updated
02/11/2021
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