Provider Demographics
NPI:1588794556
Name:LAMOT-WASIK, LIDIA IRENA (MD)
Entity type:Individual
Prefix:DR
First Name:LIDIA
Middle Name:IRENA
Last Name:LAMOT-WASIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LIDIA
Other - Middle Name:IRENA
Other - Last Name:STANEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-647-2900
Mailing Address - Fax:859-647-0140
Practice Address - Street 1:8726 US HWY 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-9642
Practice Address - Country:US
Practice Address - Phone:859-647-2900
Practice Address - Fax:859-647-0140
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043484207Q00000X
KY46203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01305566OtherRR MEDICARE
IN100325830Medicaid
KY7100267190Medicaid
IN000000520153OtherANTHEM PROVIDER NUMBER
INF36084Medicare UPIN
KY7100267190Medicaid
IN921480PPMedicare PIN
KYK108160Medicare PIN