Provider Demographics
NPI:1285625566
Name:LENTZ, DAVID E (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:LENTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7980 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4170
Practice Address - Country:US
Practice Address - Phone:260-478-5160
Practice Address - Fax:260-432-6524
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001826A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000001043OtherMPLAN
IN080143877OtherRAILROAD MEDICARE
10117OtherPHYSICIANS HEALTH PLAN
INQ00723960OtherRAILROAD PTAN
IN1100182712OtherANTHEM PTAN
IN200102480Medicaid
000000091887OtherBLUE CROSS BLUE SHIELD
INP02689456OtherRAILROAD PTAN
IN925510HMedicare PIN