MEDICARE: LAFAYETTE OTOLARYNGOLOGY ASSOCIATES, INC

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	207Y00000X	Otolaryngology Physician

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	:	1720157951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAFAYETTE OTOLARYNGOLOGY ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	2320 CONCORD RD
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47909-2708
Country	:	US
Telephone Number	:	765-477-7436
Fax Number	:	765-477-1245

Provider Business Practice Location Address
First Line	:	2320 CONCORD RD
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47909-2708
Country	:	US
Telephone Number	:	765-477-7436
Fax Number	:	765-477-1245

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	RUTH M RODEHAN
Credential	:
Telephone Number	:	765-477-7436

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	12/27/2010

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