Healthcare Provider Details

I. General information

NPI: 1922031913
Provider Name (Legal Business Name): MANUEL LEONARDO LOZANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N STATE ST STE 100
GREENFIELD IN
46140-1270
US

IV. Provider business mailing address

156 W. MUSKEGON DRIVE
GREENFIELD IN
46140-3069
US

V. Phone/Fax

Practice location:
  • Phone: 317-462-3255
  • Fax: 317-462-7648
Mailing address:
  • Phone: 317-468-6270
  • Fax: 317-468-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD00046719
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01075312A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: