Provider Demographics
NPI:1841205424
Name:PAPENFUS, LODEWYK R (MD)
Entity Type:Individual
Prefix:DR
First Name:LODEWYK
Middle Name:R
Last Name:PAPENFUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1002 MOCKINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4923
Mailing Address - Country:US
Mailing Address - Phone:308-220-4059
Mailing Address - Fax:308-630-2149
Practice Address - Street 1:3911 AVENUE B
Practice Address - Street 2:SUITE 1100
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4617
Practice Address - Country:US
Practice Address - Phone:308-630-2100
Practice Address - Fax:308-630-2113
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE21968207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080176395OtherPALMENTO GBA RR MEDICARE
NEH45700Medicare UPIN
274463Medicare PIN