Provider Demographics
NPI:1851374961
Name:LENTZ, KIMBERLY JO (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:JO
Last Name:LENTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1500 W OAK ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1826
Mailing Address - Country:US
Mailing Address - Phone:317-708-3708
Mailing Address - Fax:317-733-4422
Practice Address - Street 1:1500 W OAK ST
Practice Address - Street 2:SUITE 500
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1826
Practice Address - Country:US
Practice Address - Phone:317-708-3708
Practice Address - Fax:317-733-4422
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01040586A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100467650Medicaid
IN220620TTMedicare PIN
IN100467650Medicaid