Provider Demographics
NPI:1023334828
Name:BURUGU, SHIVAKANTH (MD)
Entity type:Individual
Prefix:
First Name:SHIVAKANTH
Middle Name:
Last Name:BURUGU
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 1:300 W SAINT MARY BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-4638
Mailing Address - Country:US
Mailing Address - Phone:337-233-6593
Mailing Address - Fax:337-235-1032
Practice Address - Street 1:224 N LEWIS ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2841
Practice Address - Country:US
Practice Address - Phone:337-560-1144
Practice Address - Fax:337-560-1102
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD37848207RN0300X
LA321121207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2516825Medicaid