Provider Demographics
NPI:1518943505
Name:HENDRIX, LLOYD E (MD)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:E
Last Name:HENDRIX
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 1:6740 GRANADA RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-1635
Mailing Address - Country:US
Mailing Address - Phone:920-284-0678
Mailing Address - Fax:
Practice Address - Street 1:DWIGHT D EISENHOWER VA MEDICAL CENTER
Practice Address - Street 2:4101 4TH ST. TRAFFICWAY
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5014
Practice Address - Country:US
Practice Address - Phone:913-682-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI276602085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30830500Medicaid
WI30830500Medicaid
B53546Medicare UPIN
001769060Medicare ID - Type Unspecified