Provider Demographics
NPI:1740334150
Name:WAPIENNIK, LARRY JOHN II (DPM)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JOHN
Last Name:WAPIENNIK
Suffix:II
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11406 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7106
Mailing Address - Country:US
Mailing Address - Phone:219-663-7737
Mailing Address - Fax:219-663-7733
Practice Address - Street 1:11406 BROADWAY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7106
Practice Address - Country:US
Practice Address - Phone:219-663-7737
Practice Address - Fax:219-663-7733
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000898A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000080048OtherANTHEM BC BS PIN NUMBER
IN90001030OtherBC BS OF ILLINOIS
IN3789456002OtherCIGNA
IN000000080047OtherANTHEM BC BS PIN NUMBER
IN5399611OtherAETNA GROUP ID
IN7890048OtherAETNA PERSONAL ID
IN7890048OtherAETNA PERSONAL ID
IN90001030OtherBC BS OF ILLINOIS
IN3789456002OtherCIGNA
IN137530Medicare ID - Type UnspecifiedMEDICARE NUMBER