Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 01043056 | IN |
NPI | 1164525333 |
---|---|
Provider Name | Roger R Lenke |
First Address | Indianapolis, IN 46268-0952 |
Second Address | Indianapolis, IN 46260-2396 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 24/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100466550B | (05) | IN |
B98742 | (02) |