Provider Demographics
NPI:1255383758
Name:LENHOF, DAVID M (PAC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:LENHOF
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 LAKENGREN DR
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-2778
Mailing Address - Country:US
Mailing Address - Phone:937-336-5445
Mailing Address - Fax:
Practice Address - Street 1:8459 COLERAIN AVE UNIT C
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-3938
Practice Address - Country:US
Practice Address - Phone:614-505-7633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001093363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0072509Medicaid
P04498Medicare UPIN
OHH131822Medicare PIN