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General NPI Number Information
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NPI Number | 1912967316
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Entity Type | Organization
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Legal Business Name | KENNETH J. CHAMPAGNE, M.D., APMC
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 12/20/2019
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Provider Practice Location Address
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Address Line | 102 DRURY LN
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City | LAFAYETTE
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State | LA
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Zip | 70508-5702
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Country | US
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Telephone | 337-233-0219
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Fax | 337-233-2418
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Provider Business Mailing Address
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Address Line | 102 DRURY LN
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City | LAFAYETTE
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State | LA
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Zip | 70508-5702
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Country | US
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Telephone | 372-233-0219
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Fax | 337-233-2418
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. SONDRA A. BERNARD
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Credential | RHIA
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Telephone | 337-233-0219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 017238
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License Number State | LA
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