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General NPI Number Information
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NPI Number | 1336299056
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Entity Type | Organization
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Legal Business Name | KENNETH D FUTCH, MD, AMC
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 155 HOSPITAL DR STE 101
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City | LAFAYETTE
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State | LA
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Zip | 70503-2852
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Country | US
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Telephone | 337-269-9777
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 52507
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City | LAFAYETTE
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State | LA
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Zip | 70505-2507
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Country | US
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Telephone | 337-269-9777
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH D FUTCH
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Credential | MD
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Telephone | 337-269-9777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 010958
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License Number State | LA
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