Individual
KENNY KALUBABARI MSIAKII
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
610 MARSHALL ST, SUITE #501, SHREVEPORT, LA 71101-3784
(318) 222-6656
(318) 222-6656
Mailing address
610 MARSHALL ST, SUITE #501, SHREVEPORT, LA 71101-3784
(318) 222-6656
(318) 222-6656
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
COC0700223
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12742742
DRIVER LICENSE
TX
Enumeration date
03/23/2007
Last updated
11/29/2007
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