| Lafayette Med, PLLC | |
|
1563 Sun Ridge Dr Bourbonnais IL 60914-9644 | |
| (815) 908-9685 | |
| Not Available |
| Full Name | Lafayette Med, PLLC |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 1563 Sun Ridge Dr, Bourbonnais, Illinois |
| Authorized Official Name and Position | K-shayla Lafayette (NURSE PRACTITIONER/MANAGER) |
| Authorized Official Contact | 8159089685 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lafayette Med, PLLC 1563 Sun Ridge Dr Bourbonnais IL 60914-9644 Ph: (815) 908-9685 | Lafayette Med, PLLC 1563 Sun Ridge Dr Bourbonnais IL 60914-9644 Ph: (815) 908-9685 |
| NPI Number | 1922827542 |
|---|---|
| Provider Enumeration Date | 10/09/2024 |
| Last Update Date | 10/09/2024 |
| Certification Date | 10/09/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922827542 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
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Keith A. Moss, M.D., SC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 300 Riverside Dr, Suite 2400, Bourbonnais, IL 60914 Phone: 815-935-2784 Fax: 815-935-5687 |
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