Individual
DR. LUELLA BANGURA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5 EXECUTIVE DR STE G, LAFAYETTE, IN 47905-4867
(765) 448-4646
(765) 448-4791
Mailing address
13 S BROOKFIELD DR, LAFAYETTE, IN 47905-7658
(765) 447-7941
(765) 447-4206
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01045193A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000520469
ANTHEM PROVIDER PIN
IN
05
—
200421310
—
IN
Enumeration date
08/01/2006
Last updated
12/11/2012
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