NPIMap

Organization Active NPI

Louisiana Neurologic Clinic AMC

  • Neurological Surgery Physician
  • Shreveport, LA
National Provider Identifier
1619969292
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
LOUISIANA NEUROLOGIC CLINIC AMC
Practice address
1666 E Bert Kouns Loop
Suite 140
Shreveport, LA 71105-5714
Phone
(318) 797-5400
Fax
(318) 797-5405
NPI assigned
Aug 18, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Krzysztof K Kundo, MD
Title
Owner
Phone
(318) 797-5400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207T00000X LA Primary

Addresses

Primary practice location

1666 E Bert Kouns Loop
Suite 140
Shreveport, LA 71105-5714

Mailing address

1666 E Bert Kouns Loop
Suite 140
Shreveport, LA 71105-5714
Phone (318) 797-5400

Other identifiers 1

IdentifierTypeStateIssuer
1661970MedicaidLA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1619969292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1666 E BERT KOUNS LOOP",
            "address_2": "SUITE 140",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055714",
            "telephone_number": "318-797-5400",
            "fax_number": "318-797-5405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1666 E BERT KOUNS LOOP",
            "address_2": "SUITE 140",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055714",
            "telephone_number": "318-797-5400",
            "fax_number": "318-797-5405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUISIANA NEUROLOGIC CLINIC AMC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-18",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KUNDO",
        "authorized_official_first_name": "KRZYSZTOF",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-797-5400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1661970",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.