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NPI Code Detail

MEDICARE: LAKEPOINTE INTERNAL MEDICINE, LLC

MEDICARE: LAKEPOINTE INTERNAL MEDICINE, 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
1207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1780745711
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKEPOINTE INTERNAL MEDICINE, LLC
Provider Business Mailing Address
First Line : 7201 E VIRGINIA ST STE D
Second Line :
City : EVANSVILLE
State : IN
Zip : 47715-4072
Country : US
Telephone Number : 812-471-7859
Fax Number : 812-471-7912
Provider Business Practice Location Address
First Line : 7201 E VIRGINIA ST
Second Line : STE D
City : EVANSVILLE
State : IN
Zip : 47715-4072
Country : US
Telephone Number : 812-471-7859
Fax Number : 812-471-7912
Authorized Official
Title or Position : MANAGING MEMBER
Name : DR. KENNETH G COMBS
Credential : MD
Telephone Number : 812-471-7859
Provider Enumeration Date : 12/13/2006
Last Update Date : 09/08/2009

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Directions to “LAKEPOINTE INTERNAL MEDICINE, LLC ” Practice Location

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