| Executive Medical Clinic Of Lake Charles | |
|
765 East Bayou Pines Drive Lake Charles LA 70601-5690 | |
| (337) 210-1260 | |
| Not Available |
| Full Name | Executive Medical Clinic Of Lake Charles |
|---|---|
| Speciality | Family Medicine |
| Location | 765 East Bayou Pines Drive, Lake Charles, Louisiana |
| Authorized Official Name and Position | Melissa Lebrun (PRESIDENT) |
| Authorized Official Contact | 2259390050 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Executive Medical Clinic Of Lake Charles 765 East Bayou Pines Drive Lake Charles LA 70601-5690 Ph: (337) 210-1260 | Executive Medical Clinic Of Lake Charles 765 East Bayou Pines Drive Lake Charles LA 70601-5690 Ph: (337) 210-1260 |
| NPI Number | 1982126520 |
|---|---|
| Provider Enumeration Date | 07/14/2017 |
| Last Update Date | 09/19/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982126520 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | AP06496 (Louisiana) | Primary |
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