Healthcare Provider Details

I. General information

NPI: 1912388414
Provider Name (Legal Business Name): RANDY C LEHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 HOSPITAL DR
WINAMAC IN
46996-1173
US

IV. Provider business mailing address

PO BOX 279
WINAMAC IN
46996-0279
US

V. Phone/Fax

Practice location:
  • Phone: 574-946-2194
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number68280
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number01084206A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01084206A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: