Individual
DR. KENNETH J. CHAMPAGNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
102 DRURY LN, LAFAYETTE, LA 70508-5702
(337) 233-0219
(337) 233-2418
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(337) 233-0219
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
MD.017238
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396681
—
LA
01
—
280000189
RAILROAD MEDICARE
LA
Enumeration date
06/09/2005
Last updated
10/01/2021
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