1295843134 NPI number — KENNETH D LORENZ O.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295843134 NPI number — KENNETH D LORENZ O.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LORENZ

Provider First Name:

KENNETH

Provider Middle Name:

D

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

O.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1295843134

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/18/2010

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

221 S 6TH ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

TERRE HAUTE

Provider Business Mailing Address State Name:

IN

Provider Business Mailing Address Postal Code:

47807-4214

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

812-242-3700

Provider Business Mailing Address Fax Number:

812-234-3565

Provider First Line Business Practice Location Address:

422 POPLAR ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

TERRE HAUTE

Provider Business Practice Location Address State Name:

IN

Provider Business Practice Location Address Postal Code:

47807-4209

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

812-242-3700

Provider Business Practice Location Address Fax Number:

812-234-3565

Provider Enumeration Date:

08/29/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 152W00000X , with the licence number:  18001615A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 000000089617 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
• Identifier: 02096 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 243410 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
• Identifier: 791580270 . This is a "RAILROAD MCARE PALAMETTO" identifier . This identifiers is of the category "OTHER".
• Identifier: N280839 . This is a "HARMONY HEALTH PLAN IND" identifier . This identifiers is of the category "OTHER".
• Identifier: 0182864 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
• Identifier: I017569C004 . This is a "UNISYS CHAMPUS SECONDARY" identifier . This identifiers is of the category "OTHER".
• Identifier: 100150840D . This is a "MOLINA HEALTHCARE MCAID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
• Identifier: P00834935 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
• Identifier: 100150840 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
• Identifier: 351904269136 . This is a "CARESOURCE MEDICAID" identifier . This identifiers is of the category "OTHER".
• Identifier: 4351954 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".