MEDICARE: MID-MO LUNG ASSOCIATES, 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	207RP1001X	Pulmonary Disease Physician	117893	MO

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	:	1851671689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-MO LUNG ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	1801 BROOKFIELD MNR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-6246
Country	:	US
Telephone Number	:	573-815-7118
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 BROOKFIELD MNR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-6246
Country	:	US
Telephone Number	:	573-815-7118
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HUMAYUN LODHI
Credential	:	MD
Telephone Number	:	573-815-7118

Provider Enumeration Date	:	08/24/2011
Last Update Date	:	08/29/2011

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