Provider Demographics
NPI:1184832057
Name:LOIS K LAMBRECHT MD PC
Entity Type:Organization
Organization Name:LOIS K LAMBRECHT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:K
Authorized Official - Last Name:LAMBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-333-0922
Mailing Address - Street 1:2401 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-2069
Mailing Address - Country:US
Mailing Address - Phone:812-333-0922
Mailing Address - Fax:812-333-0961
Practice Address - Street 1:2401 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-2069
Practice Address - Country:US
Practice Address - Phone:812-333-0922
Practice Address - Fax:812-333-0961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030430A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100185110Medicaid
IN546650Medicare PIN
IN100185110Medicaid