Individual
CARMEN ENID KOUBICEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1270 ATTAKAPAS DR, SUITE 401 K, OPELOUSAS, LA 70570
(337) 407-0084
(337) 407-0084
Mailing address
1270 ATTAKAPAS DR, SUITE 401 K, OPELOUSAS, LA 70570
(337) 407-0084
(337) 407-0094
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
13448R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13448R
STATE MED LICENSE
LA
05
—
1565911
—
LA
01
—
1900972
CLIA
LA
Enumeration date
01/11/2007
Last updated
07/09/2007
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