Carmen Enid Koubicek, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

13448R Issued in LA

Practice address

1270 Attakapas Dr
Suite 401 K
Opelousas, LA 70570

Phone

(337) 407-0084

Fax

(337) 407-0084

NPI assigned

Jan 11, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1992855282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1270 ATTAKAPAS DR",
            "address_2": "SUITE 401 K",
            "city": "OPELOUSAS",
            "state": "LA",
            "postal_code": "70570",
            "telephone_number": "337-407-0084",
            "fax_number": "337-407-0094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1270 ATTAKAPAS DR",
            "address_2": "SUITE 401 K",
            "city": "OPELOUSAS",
            "state": "LA",
            "postal_code": "70570",
            "telephone_number": "337-407-0084",
            "fax_number": "337-407-0084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOUBICEK",
        "first_name": "CARMEN",
        "middle_name": "ENID",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-11",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "13448R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MED LICENSE",
            "identifier": "13448R",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "1900972",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1565911",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Opelousas, LA
• Pediatrics Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.