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General NPI Number Information
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NPI Number | 1689625824
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Entity Type | Individual
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Provider Name | LAURA CHILES LARCH M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 04/04/2024
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Provider Practice Location Address
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Address Line | 301 GORDON GUTMANN BLVD STE 101
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-3765
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Country | US
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Telephone | 812-282-4844
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Fax | 812-282-6248
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-6351
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Country | US
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Telephone | 502-559-9337
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Fax | 502-272-5339
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01061222A
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License Number State | IN
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