Basic Information
Provider Information
NPI: 1912264110
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LANGHEINZ
FirstName: KIRK
MiddleName: PHILIP
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 54287
Address2:  
City: NEW ORLEANS
State: LA
PostalCode: 701544287
CountryCode: US
TelephoneNumber: 3372898222
FaxNumber: 3372898223
Practice Location
Address1: 1448 S COLLEGE RD
Address2:  
City: LAFAYETTE
State: LA
PostalCode: 705032920
CountryCode: US
TelephoneNumber: 3372898222
FaxNumber: 3372898223
Other Information
ProviderEnumerationDate: 04/12/2012
LastUpdateDate: 07/23/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/23/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X305111LAY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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