| |
5 Executive Dr Suite B1 Lafayette IN 47905-3832 | |
(765) 807-0531 | |
(765) 807-0534 |
Full Name | |
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Speciality | Internal Medicine - Gastroenterology |
Location | 5 Executive Dr, Lafayette, Indiana |
Authorized Official Name and Position | Martha K Miller (DIRECTOR OF BILLING) |
Authorized Official Contact | 7654465286 |
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) 446-5417 | 5 Executive Dr Suite B1 Lafayette IN 47905-3832 Ph: (765) 807-0531 |
NPI Number | 1427143205 |
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Provider Enumeration Date | 10/04/2006 |
Last Update Date | 08/19/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1427143205 | NPI | - | NPPES |
200107480 | Medicaid | IN | |
200476110 | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RG0100X | Internal Medicine - Gastroenterology | (Indiana) | Primary |
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