Provider Demographics
NPI:1285672303
Name:COURVILLE, KEVIN A (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:A
Last Name:COURVILLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80567
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-0567
Mailing Address - Country:US
Mailing Address - Phone:337-466-7474
Mailing Address - Fax:
Practice Address - Street 1:8644 EUNICE IOTA HWY
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-6749
Practice Address - Country:US
Practice Address - Phone:337-466-7474
Practice Address - Fax:337-466-7575
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.026644207RA0001X, 207RI0011X, 207UN0901X, 207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1420476Medicaid
WY11906AOtherWYOMING BOARD OF MEDICINE
LA1420476Medicaid