MEDICARE: JAMES W. LAFOLLETTE M.D.

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	207Q00000X	Family Medicine Physician	01021192A	IN

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	:	1831194828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES W. LAFOLLETTE M.D.

Provider Business Mailing Address
First Line	:	550 LANDMARK AVE.
Second Line	:	PO BOX 550
City	:	BLOOMINGTON
State	:	IN
Zip	:	47402-0550
Country	:	US
Telephone Number	:	812-332-9496
Fax Number	:	812-339-5229

Provider Business Practice Location Address
First Line	:	2605 E. CREEK'S EDGE DR.
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401
Country	:	US
Telephone Number	:	812-332-9496
Fax Number	:	812-339-5229

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	09/26/2008

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