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Contact Information

KENNETH C CIVELLO JR, MD, MPH
7777 HENNESSY BLVD
SUITE 1000
BATON ROUGE, LA70808-4300
 Phone: 225-767-3900
 Fax: 225-766-2226
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical Cardiac Electrophysiology

207RC0001X 11 Physician/Internal Medicine
 

Cardiovascular Disease

207RC0000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for KENNETH C CIVELLO JR · (Male)

NPI Number 1699745562
Status Active
Credentials MD, MPH
Entity Individual
Enumeration date 01/24/2006
Last updated 02/11/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • LA License # 201354
  • OH License # 35084798
  • LA Medicaid 1108910
  • OH Medicaid 2515157
  • Other P00225594 RAILROAD MEDICARE
  • OH Other 000000364128 ANTHEM
  • OH Other 114845 KAISER
  • OH Other 1006122 QUAL
  • OH Other E84798 SUMMA
Hospital affiliation(s)
  • OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER - (Acute Care)
    5000 HENNESSY BLVD
    BATON ROUGE, LA 70808
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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