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General NPI Number Information
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NPI Number | 1053524819
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Entity Type | Organization
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Legal Business Name | KENNETH M. SPILLER, M.D.
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4212 W CONGRESS ST SUITE 3600
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City | LAFAYETTE
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State | LA
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Zip | 70506-6765
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Country | US
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Telephone | 337-988-2004
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Fax |
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Provider Business Mailing Address
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Address Line | 4212 W CONGRESS ST SUITE 3600
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City | LAFAYETTE
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State | LA
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Zip | 70506-6765
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Country | US
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Telephone | 337-988-2004
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARIE HEBERT
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Credential |
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Telephone | 337-988-2004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L018312
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License Number State | LA
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