Provider Demographics
NPI:1760743983
Name:LENN, DAVID (IDC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:LENN
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38539 ARCOLA DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-1213
Mailing Address - Country:US
Mailing Address - Phone:586-216-0167
Mailing Address - Fax:
Practice Address - Street 1:38539 ARCOLA DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-1213
Practice Address - Country:US
Practice Address - Phone:586-216-0167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman