Provider Demographics
NPI:1619905395
Name:LEHMAN, KENT A (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:A
Last Name:LEHMAN
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 1:1521 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BERNE
Mailing Address - State:IN
Mailing Address - Zip Code:46711-1796
Mailing Address - Country:US
Mailing Address - Phone:260-589-3993
Mailing Address - Fax:260-589-2070
Practice Address - Street 1:1521 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BERNE
Practice Address - State:IN
Practice Address - Zip Code:46711-1796
Practice Address - Country:US
Practice Address - Phone:260-589-3993
Practice Address - Fax:260-589-2070
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045339A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000087488OtherANTHEM PIN
G13066Medicare UPIN
IN000000087488OtherANTHEM PIN