Provider Demographics
NPI:1649401563
Name:MEDICAL LASER CENTER LLC
Entity Type:Organization
Organization Name:MEDICAL LASER CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SODA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-986-1370
Mailing Address - Street 1:133 PLAZA DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-2087
Mailing Address - Country:US
Mailing Address - Phone:859-986-1370
Mailing Address - Fax:859-986-1374
Practice Address - Street 1:133 PLAZA DR
Practice Address - Street 2:SUITE 3
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-2087
Practice Address - Country:US
Practice Address - Phone:859-986-1370
Practice Address - Fax:859-986-1374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty