Provider Demographics
NPI:1982732061
Name:CAHILL, KELLY THERON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:THERON
Last Name:CAHILL
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3220 KALISTE SALOOM RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7422
Mailing Address - Country:US
Mailing Address - Phone:337-406-9474
Mailing Address - Fax:337-406-1027
Practice Address - Street 1:3220 KALISTE SALOOM RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7422
Practice Address - Country:US
Practice Address - Phone:337-406-9474
Practice Address - Fax:337-406-1027
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2021-01-27
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Provider Licenses
StateLicense IDTaxonomies
LAMD.200283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1075736Medicaid
LA1075736Medicaid