Provider Demographics
NPI:1790983906
Name:HUFFMAN, LANIE KAY (DPM)
Entity Type:Individual
Prefix:DR
First Name:LANIE
Middle Name:KAY
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:LANIE
Other - Middle Name:KAY
Other - Last Name:WICKHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:3731 GUION ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-7604
Mailing Address - Country:US
Mailing Address - Phone:317-931-0664
Mailing Address - Fax:317-927-0924
Practice Address - Street 1:3731 GUION ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-7604
Practice Address - Country:US
Practice Address - Phone:317-924-6241
Practice Address - Fax:317-924-4787
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001083A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200961460Medicaid
IN192530VMedicare PIN
IN4685310001Medicare NSC
INP00795018Medicare PIN