MEDICARE: LAU MEDICAL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1124686803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAU MEDICAL, LLC

Provider Business Mailing Address
First Line	:	1102 W ARGYLE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-3610
Country	:	US
Telephone Number	:	773-394-2888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1102 W ARGYLE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-3610
Country	:	US
Telephone Number	:	773-394-2888
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DENNY LAU
Credential	:
Telephone Number	:	773-394-2888

Provider Enumeration Date	:	05/29/2019
Last Update Date	:	02/04/2020

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