MEDICARE: MDL MED CORP 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	MD.200687	LA

General Provider Information

NPI Number	:	1881834406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MDL MED CORP LLC

Provider Business Mailing Address
First Line	:	2415 STONEYBROOK
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-4036
Country	:	US
Telephone Number	:	337-474-9197
Fax Number	:

Provider Business Practice Location Address
First Line	:	2415 STONEYBROOK
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-4036
Country	:	US
Telephone Number	:	337-474-9197
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK D LAFURIA
Credential	:	M.D.
Telephone Number	:	337-474-9197

Provider Enumeration Date	:	02/22/2009
Last Update Date	:	02/22/2009

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