Provider Demographics
NPI:1598144040
Name:LAYOUS LLC
Entity Type:Organization
Organization Name:LAYOUS LLC
Other - Org Name:LAYOUS MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-513-8923
Mailing Address - Street 1:1650 45TH AVE
Mailing Address - Street 2:SUITE E/ 2A
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3962
Mailing Address - Country:US
Mailing Address - Phone:219-513-8923
Mailing Address - Fax:219-513-8940
Practice Address - Street 1:1650 45TH AVE
Practice Address - Street 2:SUITE E/ 2A
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3962
Practice Address - Country:US
Practice Address - Phone:219-513-8923
Practice Address - Fax:219-513-8940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058949261QM2500X, 261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200525520AMedicaid
H51336Medicare UPIN
IN499500 RRRMedicare PIN