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5500 State Road 38 E Lafayette IN 47905-9405 | |
(765) 588-5667 | |
(765) 449-8408 |
Full Name | |
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Speciality | Clinic/center - Multi-specialty |
Location | 5500 State Road 38 E, Lafayette, Indiana |
Authorized Official Name and Position | Jon Leizman (PRESIDENT) |
Authorized Official Contact | 2164799063 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5500 Maryland Way Ste 120 Brentwood TN 37027-4993 Ph: () - | 5500 State Road 38 E Lafayette IN 47905-9405 Ph: (765) 588-5667 |
NPI Number | 1255085379 |
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Provider Enumeration Date | 02/08/2022 |
Last Update Date | 08/25/2022 |
Identifier | Type | State | Issuer |
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1255085379 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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