Provider Demographics
NPI:1720217870
Name:LEHENBAUER, DAVID GLENN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GLENN
Last Name:LEHENBAUER
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 1:3333 BURNET AVE., ML 2004
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4770
Mailing Address - Fax:513-636-3847
Practice Address - Street 1:3333 BURNET AVE., ML 2004
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229
Practice Address - Country:US
Practice Address - Phone:513-636-4770
Practice Address - Fax:513-636-3847
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01085219A208G00000X
TXP7492208G00000X
KY50932208G00000X
OH35.137228208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX385594201Medicaid