Provider Demographics
NPI:1841488798
Name:LAMB, FRED KELLEY (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:KELLEY
Last Name:LAMB
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:PO BOX 7058
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-7058
Mailing Address - Country:US
Mailing Address - Phone:812-298-9797
Mailing Address - Fax:812-298-0343
Practice Address - Street 1:1019 E SPRINGHILL DR
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4547
Practice Address - Country:US
Practice Address - Phone:812-298-9797
Practice Address - Fax:812-298-0343
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010222302081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000103895OtherANTHEM
IN271801OtherHEALTHLINK
859680Medicare PIN
IN000000103895OtherANTHEM