Healthcare Provider Details

I. General information

NPI: 1326439787
Provider Name (Legal Business Name): LUM GRANGER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7221 FIR RD
GRANGER IN
46530-0078
US

IV. Provider business mailing address

7221 FIR RD
GRANGER IN
46530-0078
US

V. Phone/Fax

Practice location:
  • Phone: 574-968-5166
  • Fax:
Mailing address:
  • Phone: 574-968-5166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12011496A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DANIEL GERARD KLAUER
Title or Position: OWNER
Credential: DDS
Phone: 574-968-5166