Organization
LAFAYETTE RADIOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT E MEHL MD (PRESIDENT)
(765) 446-4819
Entity
Organization
Contact information
Practice address
1501 HARTFORD ST, LAFAYETTE, IN 47904-2134
(765) 502-4000
(765) 446-4859
Mailing address
3900 ST FRANCIS WAY, SUITE 215, LAFAYETTE, IN 47905-4925
(765) 446-4819
(765) 466-4959
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200856080
—
IN
01
—
DG0872
RR MEDICARE
IN
Enumeration date
01/25/2007
Last updated
03/21/2012
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