Provider Demographics
NPI:1942539044
Name:LAFAYETTE DIAGNOSTICS, INC.
Entity Type:Organization
Organization Name:LAFAYETTE DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YERBOL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSHIMBAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-381-6758
Mailing Address - Street 1:12550 WHITTINGTON DR
Mailing Address - Street 2:SUITE # 804
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-4800
Mailing Address - Country:US
Mailing Address - Phone:337-214-4199
Mailing Address - Fax:
Practice Address - Street 1:1019 KALISTE SALOOM RD
Practice Address - Street 2:SUITE # 711
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4935
Practice Address - Country:US
Practice Address - Phone:337-214-4399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty