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166 Sagamore Pkwy W W Lafayette IN 47906-1569 | |
(765) 497-2428 | |
(765) 497-4251 |
Full Name | |
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Speciality | Internal Medicine |
Location | 166 Sagamore Pkwy W, W Lafayette, Indiana |
Authorized Official Name and Position | Heather Dawson (DIRECTOR OF BILLING) |
Authorized Official Contact | 7654465417 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 4699 Lafayette IN 47903-4699 Ph: (765) 449-2732 | 166 Sagamore Pkwy W W Lafayette IN 47906-1569 Ph: (765) 497-2428 |
NPI Number | 1144493883 |
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Provider Enumeration Date | 04/02/2008 |
Last Update Date | 10/18/2024 |
Identifier | Type | State | Issuer |
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1144493883 | NPI | - | NPPES |
200107480G | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
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207R00000X | Internal Medicine | 01048719A (Indiana) | Primary |