Provider Demographics
NPI:1497806848
Name:WAPIENNIK, LARRY J (DPM)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:J
Last Name:WAPIENNIK
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 1:11406 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7106
Mailing Address - Country:US
Mailing Address - Phone:219-663-7737
Mailing Address - Fax:219-663-7733
Practice Address - Street 1:11406 BROADWAY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7106
Practice Address - Country:US
Practice Address - Phone:219-663-7737
Practice Address - Fax:219-663-7733
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000451A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000086346OtherANTHEM
IN000000086347OtherANTHEM
IN90001028OtherBLUE CROSS BLUE SHIELD IL
IN8615234002OtherCIGNA
IN480014055OtherRAILROAD MEDICARE
INT34984Medicare UPIN
IN000000086346OtherANTHEM