Provider Demographics
NPI:1588254791
Name:LAFAYETTE SURGERY CENTER LLC
Entity type:Organization
Organization Name:LAFAYETTE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOWLOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-706-7246
Mailing Address - Street 1:PO BOX 772723
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2723
Mailing Address - Country:US
Mailing Address - Phone:765-807-2780
Mailing Address - Fax:317-706-3417
Practice Address - Street 1:3738 LANDMARK DR STE C
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-6655
Practice Address - Country:US
Practice Address - Phone:765-807-2780
Practice Address - Fax:317-706-3417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical