Healthcare Provider Details

I. General information

NPI: 1720109929
Provider Name (Legal Business Name): LANCE TREXLER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 SHORE DR
INDIANAPOLIS IN
46254-2607
US

IV. Provider business mailing address

9531 VALPARAISO CT
INDIANAPOLIS IN
46268-1130
US

V. Phone/Fax

Practice location:
  • Phone: 317-329-2000
  • Fax:
Mailing address:
  • Phone: 317-879-8940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number20010506A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: