| Lafayette Dpc-1 | |
|
2701b Kent Ave W Lafayette IN 47906-1350 | |
| (812) 308-8400 | |
| (765) 600-9796 |
| Full Name | Lafayette Dpc-1 |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 2701b Kent Ave, W Lafayette, Indiana |
| Authorized Official Name and Position | Mark Kemble (VP OF MEDICAL AFFAIRS) |
| Authorized Official Contact | 8645010815 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lafayette Dpc-1 10 Centimeters Dr Mauldin SC 29662-3278 Ph: (864) 501-0751 | Lafayette Dpc-1 2701b Kent Ave W Lafayette IN 47906-1350 Ph: (812) 308-8400 |
| NPI Number | 1952924896 |
|---|---|
| Provider Enumeration Date | 05/27/2020 |
| Last Update Date | 09/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952924896 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Gagan S Chadha, Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 166 Sagamore Pkwy W, W Lafayette, IN 47906 Phone: 765-497-2428 Fax: 765-497-4251 |