Provider Demographics
NPI:1386630838
Name:LENTZ, PAUL J JR (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:LENTZ
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:777 KIMOLE LN
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1478
Mailing Address - Country:US
Mailing Address - Phone:517-263-5655
Mailing Address - Fax:517-263-8012
Practice Address - Street 1:777 KIMOLE LN
Practice Address - Street 2:SUITE 230
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1478
Practice Address - Country:US
Practice Address - Phone:517-263-5655
Practice Address - Fax:517-263-8012
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI4301049176207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA76745Medicare UPIN