Provider Demographics
NPI:1568858082
Name:CHAMPAGNE, KYLE FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:FRANCIS
Last Name:CHAMPAGNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0002
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:8119 PICARDY AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3515
Practice Address - Country:US
Practice Address - Phone:225-765-5500
Practice Address - Fax:225-214-3639
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA303515207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2389289Medicaid