Provider Demographics
NPI:1316561871
Name:TAN, HENDRIK RYAN LUMAKANG (DPM)
Entity Type:Individual
Prefix:
First Name:HENDRIK RYAN
Middle Name:LUMAKANG
Last Name:TAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8615 US 31 STE B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-0972
Mailing Address - Country:US
Mailing Address - Phone:317-297-0661
Mailing Address - Fax:
Practice Address - Street 1:5471 GEORGETOWN RD STE C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5794
Practice Address - Country:US
Practice Address - Phone:317-297-0661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001406A213ES0103X
COPDT.0000593390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery