Provider Demographics
NPI:1821075953
Name:WUEST, LAWRENCE F (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:F
Last Name:WUEST
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 1:3702 NEW VISION DR BLDG B
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1331 MINNICH RD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-2051
Practice Address - Country:US
Practice Address - Phone:260-425-5000
Practice Address - Fax:260-425-5048
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036902A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN3937240005OtherMEDICARE DMEPOS
IN080130032OtherRAILROAD MEDICARE
IN100081740Medicaid
4207133OtherAETNA
IN000000111936OtherANTHEM
00000814257 07OtherUNITED HEALTHCARE
IN2030OtherPHYSICIANS HEALTH PLAN
IN080140740OtherRAILROAD MEDICARE
IN100081740Medicaid
IN069860KMedicare PIN