Provider Demographics
NPI:1821058322
Name:LACHENMAIER, REBECCA L (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:LACHENMAIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1215 PLEASANT ST
Mailing Address - Street 2:STE 506
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1416
Mailing Address - Country:US
Mailing Address - Phone:515-241-4030
Mailing Address - Fax:515-241-4031
Practice Address - Street 1:1215 PLEASANT ST
Practice Address - Street 2:STE 506
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1416
Practice Address - Country:US
Practice Address - Phone:515-241-4030
Practice Address - Fax:515-241-4031
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA35125207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0416024Medicaid
IA1821058322Medicaid
IAI22140011Medicare PIN
IAH92261Medicare UPIN
IA0416024Medicaid
IAP00060539Medicare PIN
IAI10390Medicare PIN