Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Executive Medical Clinic of Lake Charles

Organization Family Medicine Physician · NPI 1982126520

Executive Medical Clinic of Lake Charles is a Family Medicine Physician in Lake Charles, Louisiana. Licensed in Louisiana. Registered with an NPI since 2017.

Licensed in
LA
In the registry since
2017

Practice location Address checks out

765 E Bayou Pines Dr
Lake Charles, LA 70601-5690
Phone: (337) 210-1260
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence AP06496 (LA)

Record details

NPI number1982126520
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Melissa Lebrun — President · (225) 939-0050
NPI enumeratedJuly 14, 2017
Last updated in NPPESSeptember 19, 2022
Certification dateSeptember 14, 2022
Mailing address765 East Bayou Pines Drive, Lake Charles, LA 70601-5690

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