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NPI Code Detail

MEDICARE: DAVID E LENTZ DO

MEDICARE: DAVID E LENTZ DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician02001826AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2080143877OTHERINRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000001043OTHERMPLAN
310117OTHERPHYSICIANS HEALTH PLAN
4Q00723960OTHERINRAILROAD PTAN
51100182712OTHERINANTHEM PTAN
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7000000091887OTHERBLUE CROSS BLUE SHIELD
8P02689456OTHERINRAILROAD PTAN

General Provider Information

NPI Number : 1285625566
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID E LENTZ DO
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7980 W JEFFERSON BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-4170
Country : US
Telephone Number : 260-478-5160
Fax Number : 260-432-6524
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2005
Last Update Date : 12/30/2024

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Directions to “ DAVID E LENTZ DO” Practice Location

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