| Organization Name: | LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS |
| NPI Number: | 1134235047 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RANDY SAMUELSON (ADMINISTRATOR) |
| Mailing Address: | 129 Old Abe Rd Lac Du Flambeau |
| State: | WI US |
| Postal Code: | 545389386 |
| Phone Number: | 7155883371 |
| Fax Number: | 7155882031 |
| NPI Enumeration Date: | 08/22/2006 |
| NPI Last Update Date: | 09/03/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |