Healthcare Provider Details

I. General information

NPI: 1639374879
Provider Name (Legal Business Name): TIFFANY LAHR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1852 ASHBURN DR
GOSHEN IN
46526-6537
US

IV. Provider business mailing address

1852 ASHBURN DR
GOSHEN IN
46526-6537
US

V. Phone/Fax

Practice location:
  • Phone: 574-533-5808
  • Fax: 574-534-7215
Mailing address:
  • Phone: 574-533-5808
  • Fax: 574-534-7215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL16399
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number99058810A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: