Provider Demographics
NPI:1043220239
Name:SPILLER, KENNETH M (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:M
Last Name:SPILLER
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 1:4811 AMBASSADOR CAFFERY PKWY STE 305
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7266
Mailing Address - Country:US
Mailing Address - Phone:337-470-3109
Mailing Address - Fax:337-470-3110
Practice Address - Street 1:4809 AMBASSADOR CAFFERY PKWY STE 305
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8800
Practice Address - Country:US
Practice Address - Phone:337-470-3109
Practice Address - Fax:337-470-3110
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL018312207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1355984Medicaid
LACK2924OtherRAILROAD MEDICARE
LA51255Medicare PIN
LACK2924OtherRAILROAD MEDICARE