Provider Demographics
NPI:1447542360
Name:KEVIN COURVILLE, M.D.
Entity type:Organization
Organization Name:KEVIN COURVILLE, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COURVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-534-4356
Mailing Address - Street 1:PO BOX 82488
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-2488
Mailing Address - Country:US
Mailing Address - Phone:337-534-4356
Mailing Address - Fax:
Practice Address - Street 1:935 CAMELLIA BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7084
Practice Address - Country:US
Practice Address - Phone:337-534-4356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA026644207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty