Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 45644 | KY |
NPI | 1023207859 |
---|---|
Provider Name | Lawrence Tenkman |
First Address | Louisville, KY 40215-1179 |
Second Address | Louisville, KY 40215-1179 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2007 |
Last Update Date | 14/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0075981 | (05) | OH |
201025590 | (05) | IN |
331420001 | MEDICARE (01) | IN |
7100224410 | (05) | KY |
P01097674 | MEDICARE RR (01) |