MEDICARE: LOUIS EDWARD LAMANCUSA MD

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	2084N0400X	Neurology Physician	021460	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275629859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUIS EDWARD LAMANCUSA MD

Provider Business Mailing Address
First Line	:	PO BOX 1928
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36302-1928
Country	:	US
Telephone Number	:	334-712-3635
Fax Number	:	334-699-4387

Provider Business Practice Location Address
First Line	:	7441 LAKE MEAD #159
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	98128
Country	:	US
Telephone Number	:	702-461-6046
Fax Number	:	702-870-3997

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	02/18/2021

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