Provider Demographics
NPI:1063404390
Name:TRAN, LAU (MD)
Entity type:Individual
Prefix:
First Name:LAU
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:IN
Mailing Address - Zip Code:47443-0236
Mailing Address - Country:US
Mailing Address - Phone:812-659-7600
Mailing Address - Fax:812-659-7601
Practice Address - Street 1:195 EAST BROAD ST
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:IN
Practice Address - Zip Code:47443-0236
Practice Address - Country:US
Practice Address - Phone:812-659-7600
Practice Address - Fax:812-659-7601
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100124600Medicaid
IN300610Medicare ID - Type Unspecified
D69529Medicare UPIN