Basic Information
| Provider Information | |||||||||
| NPI: | 1245207513 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAMBIASE | ||||||||
| FirstName: | LOUIS | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 975 E. THIRD STREET | ||||||||
| Address2: | ATTN: PROVIDER ENROLLMENT | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237784830 | ||||||||
| FaxNumber: | 4237786154 | ||||||||
| Practice Location | |||||||||
| Address1: | 979 E. THIRD STREET | ||||||||
| Address2: | SUITE C-825 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237784830 | ||||||||
| FaxNumber: | 4237786154 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2006 | ||||||||
| LastUpdateDate: | 07/10/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 44678 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207R00000X | 44678 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000811775A | 05 | GA | MEDICAID |