Provider Demographics
NPI:1023207859
Name:TENKMAN, LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:TENKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 BLUEGRASS AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1179
Mailing Address - Country:US
Mailing Address - Phone:502-895-0040
Mailing Address - Fax:502-361-4488
Practice Address - Street 1:1935 BLUEGRASS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1179
Practice Address - Country:US
Practice Address - Phone:502-895-0040
Practice Address - Fax:502-361-4488
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45644207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01097674OtherMEDICARE RR
IN331420001OtherMEDICARE
IN201025590Medicaid
OH0075981Medicaid
KY7100224410Medicaid
OHH139140Medicare PIN
KYK054330Medicare PIN
OHH139140Medicare PIN