Kenneth Mekelburg MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

13801R Issued in LA

Legal business name

KENNETH MEKELBURG MD

Practice address

2525 Viking Drive
Bossier City, LA 71111-2103

Phone

(318) 425-4096

Fax

(318) 681-6812

NPI assigned

Jun 16, 2008

Last updated

Jan 10, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kenneth John Mekelburg, MDNPI 1619975166

Title

MD/Owner

Phone

(318) 425-4096

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kenneth John Mekelburg, M.D.

  • Internal Medicine Physician
  • Bossier City, LA
  • NPI 1619975166
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326153600000",
    "number": "1245490945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1684",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711651684",
            "telephone_number": "318-425-4096",
            "fax_number": "318-681-6812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 VIKING DRIVE",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112103",
            "telephone_number": "318-425-4096",
            "fax_number": "318-681-6812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH MEKELBURG MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-16",
        "last_updated": "2012-01-10",
        "status": "A",
        "authorized_official_last_name": "MEKELBURG",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "318-425-4096",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "LA",
            "license": "13801R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1436836",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carl Aris Kelly III, O.D.
• Mallory Jane Kelly
• Nancy Lynne Kelly
• Kennedy K Lim MD and Willis-Knighton Medical Center
• Jennifer Kennedy, RN, IBCLC
• George Michael Kent, M.D.
• Katy Amorelle Kent, OTR/L
• Michelle Kerouac
• Key Pieces Therapy LLC
• Kelly N Key, OTR

• Specialist in Bossier City, LA
• Providers in Bossier City, LA by specialty
• Specialist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.