Organization
BANGURA MEDICAL SERVICES,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUELLA BANGURA MD (PRESIDENT/OWNER)
(765) 447-7941
Entity
Organization
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
05
—
200421310A
—
IN
Enumeration date
08/04/2006
Last updated
12/11/2012
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