Provider Demographics
NPI:1962598540
Name:KAWASAKI, GILO (MD)
Entity type:Individual
Prefix:
First Name:GILO
Middle Name:
Last Name:KAWASAKI
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 1:60491 DOSS DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-4972
Mailing Address - Country:US
Mailing Address - Phone:985-690-2635
Mailing Address - Fax:
Practice Address - Street 1:60491 DOSS DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460-4972
Practice Address - Country:US
Practice Address - Phone:985-690-2635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6869207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8W2025OtherBCBS
E41873Medicare UPIN
TX8J0629Medicare PIN