Provider Demographics
NPI:1710685896
Name:LAFAYETTE VEIN AND VASCULAR CENTER LLC
Entity Type:Organization
Organization Name:LAFAYETTE VEIN AND VASCULAR CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOAIB
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-938-3989
Mailing Address - Street 1:2809 IBIS CT
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-6625
Mailing Address - Country:US
Mailing Address - Phone:765-404-1454
Mailing Address - Fax:
Practice Address - Street 1:3900 ST FRANCIS WAY STE 201
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4925
Practice Address - Country:US
Practice Address - Phone:765-404-1454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty