MEDICARE: LAKETOWN LANGUAGE, 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	171R00000X	Interpreter

General Provider Information

NPI Number	:	1427590553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKETOWN LANGUAGE, LLC

Provider Business Mailing Address
First Line	:	2817 ANTHONY LN S
Second Line	:	SUITE 106
City	:	ST ANTHONY
State	:	MN
Zip	:	55418-3254
Country	:	US
Telephone Number	:	619-246-0239
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 ANTHONY LN S
Second Line	:	SUITE 106
City	:	ST ANTHONY
State	:	MN
Zip	:	55418-3254
Country	:	US
Telephone Number	:	619-246-0239
Fax Number	:

Authorized Official
Title or Position	:	CEO/ PRESIDENT
Name	:	NASIR BUDUL
Credential	:
Telephone Number	:	619-246-0239

Provider Enumeration Date	:	11/07/2016
Last Update Date	:	11/07/2016

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Directions to “LAKETOWN LANGUAGE, LLC ” Practice Location

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