Provider Demographics
NPI:1104087634
Name:BRAKTA, KAMEL (MD)
Entity type:Individual
Prefix:
First Name:KAMEL
Middle Name:
Last Name:BRAKTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2551 GREENWOOD RD STE 311
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3981
Mailing Address - Country:US
Mailing Address - Phone:318-212-6270
Mailing Address - Fax:318-212-6275
Practice Address - Street 1:2551 GREENWOOD RD STE 311
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3981
Practice Address - Country:US
Practice Address - Phone:318-212-6270
Practice Address - Fax:318-212-6275
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2022-02-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.206464208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery