Basic Information
| Provider Information | |||||||||
| NPI: | 1518349919 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KFOURY | ||||||||
| FirstName: | BADER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5959 S SHERWOOD FOREST BLVD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708166038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257655727 | ||||||||
| FaxNumber: | 2257654278 | ||||||||
| Practice Location | |||||||||
| Address1: | 4630 AMBASSADOR CAFFERY PKWY | ||||||||
| Address2: | STE 408 | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705086950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374703980 | ||||||||
| FaxNumber: | 3374703989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2015 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 02/02/2016 | ||||||||
| NPIReactivationDate: | 03/07/2016 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | PENDING | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 390200000X | 244202 | NY | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | NY | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | MT216942 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RN0300X | 324281 | LA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.