Provider Demographics
NPI:1497825004
Name:LEMMEN, ROGER D (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:D
Last Name:LEMMEN
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 1:360 N MAIN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:BLUFFTON
Mailing Address - State:IN
Mailing Address - Zip Code:46714-2041
Mailing Address - Country:US
Mailing Address - Phone:260-353-3375
Mailing Address - Fax:260-353-3377
Practice Address - Street 1:360 N MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-2041
Practice Address - Country:US
Practice Address - Phone:260-353-3375
Practice Address - Fax:260-353-3377
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010467112084P2900X
IN01064091A2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3374917Medicaid
IN200917750Medicaid
MI3374917Medicaid
IN256410Medicare UPIN
IN200917750Medicaid