MEDICARE: LCD CLINIC 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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1770433120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LCD CLINIC LLC

Provider Business Mailing Address
First Line	:	105 DR MICHAEL DEBAKEY DR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-5950
Country	:	US
Telephone Number	:	337-240-6183
Fax Number	:	337-338-9347

Provider Business Practice Location Address
First Line	:	105 DR MICHAEL DEBAKEY DR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-5950
Country	:	US
Telephone Number	:	337-240-6183
Fax Number	:	337-338-9347

Authorized Official
Title or Position	:	OWNER/MD
Name	:	JOHN MILLER
Credential	:	MD
Telephone Number	:	337-240-6183

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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