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Individual

MAMATHA KATIKANENI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 813-2528
Mailing address
1541 KINGS HWY, ATTN: PAYOR CREDENTIALING, SHREVEPORT, LA 71103-4228
(318) 626-0287

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD.206221
LA
207RR0500X
Rheumatology Physician
Primary
MD.206221
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2127578
LA
Enumeration date
07/29/2010
Last updated
07/08/2024
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