Provider Demographics
NPI:1639167562
Name:LENCKI, SHAUN G (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:G
Last Name:LENCKI
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:PO BOX 4046
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4046
Mailing Address - Country:US
Mailing Address - Phone:417-269-5712
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:1000 E PRIMROSE ST STE 360
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5293
Practice Address - Country:US
Practice Address - Phone:417-269-4037
Practice Address - Fax:417-269-6139
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86568207VM0101X
MO2020007993207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL202013798OtherTAX ID
FLN290176OtherHEALTHEASE (MEDICIAD HMO)
FL265903400Medicaid
FL62954OtherBC/BS
FL5361051OtherAETNA