=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780652586
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARC EUGENE LENAERTS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2006
-----------------------------------------------------
Last Update Date | 10/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 MEDICAL PLAZA DR STE 205
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95661-3044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-773-8711
-----------------------------------------------------
Fax | 916-503-7693
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 255228
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95865-5228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-470-0071
-----------------------------------------------------
Fax | 916-854-6769
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | C 53356
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------