Provider Demographics
NPI:1710962170
Name:FLENAR, REX A (MD)
Entity Type:Individual
Prefix:
First Name:REX
Middle Name:A
Last Name:FLENAR
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 1:130 LAKE TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:KENDALLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46755-1819
Mailing Address - Country:US
Mailing Address - Phone:260-349-9240
Mailing Address - Fax:260-349-9244
Practice Address - Street 1:130 LAKE TERRACE DR
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-1819
Practice Address - Country:US
Practice Address - Phone:260-349-9240
Practice Address - Fax:260-349-9244
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036102A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100190950Medicaid
INM400014724Medicare PIN