Healthcare Provider Details

I. General information

NPI: 1609852227
Provider Name (Legal Business Name): RICHARD L LAUTZENHEISER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8902 N MERIDIAN ST STE 210
INDIANAPOLIS IN
46260-5382
US

IV. Provider business mailing address

8902 N MERIDIAN ST STE 210
INDIANAPOLIS IN
46260-5382
US

V. Phone/Fax

Practice location:
  • Phone: 317-844-6444
  • Fax: 317-848-6605
Mailing address:
  • Phone: 317-844-6444
  • Fax: 317-848-6605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number01023335
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: