Basic Information
| Provider Information | |||||||||
| NPI: | 1972526986 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAPPEL | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | ITTMANN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1340 POYDRAS ST | ||||||||
| Address2: | SUITE 1640 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701121221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044121835 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 W ESPLANADE AVE | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | KENNER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700652489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044121705 | ||||||||
| FaxNumber: | 5044121702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 08/08/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 13482R | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 02928221 | 05 | MS | MEDICAID | 1421006 | 05 | LA | MEDICAID |