Healthcare Provider Details

I. General information

NPI: 1407858079
Provider Name (Legal Business Name): LORRAINE WEAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E BOYD AVE STE 250
GREENFIELD IN
46140-2845
US

IV. Provider business mailing address

PO BOX 129
GREENFIELD IN
46140-0129
US

V. Phone/Fax

Practice location:
  • Phone: 317-467-4500
  • Fax: 317-477-6321
Mailing address:
  • Phone: 317-468-6270
  • Fax: 317-468-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01038518A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: