1972620060 NPI number — GASTROENTEROLOGY CONSULTANTS PC

Table of content: MICHELLE L. LENZ M.D. (NPI 1932150216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972620060 NPI number — GASTROENTEROLOGY CONSULTANTS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GASTROENTEROLOGY CONSULTANTS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

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:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972620060
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13421 OLD MERIDIAN STREET
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-848-6900
Provider Business Mailing Address Fax Number:
317-848-6914

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7250 CLEARVISTA DRIVE
Provider Second Line Business Practice Location Address:
SUITE 375
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-621-2100
Provider Business Practice Location Address Fax Number:
317-621-2105
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CLARKE
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
317-848-6900

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  01034548A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100378800 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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