Provider Demographics
NPI:1881693083
Name:AILES, LONNIE R (MD)
Entity type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:R
Last Name:AILES
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 1:1551 STURDY RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-7883
Mailing Address - Country:US
Mailing Address - Phone:219-464-1365
Mailing Address - Fax:219-464-7815
Practice Address - Street 1:1551 STURDY RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-7883
Practice Address - Country:US
Practice Address - Phone:219-464-1365
Practice Address - Fax:219-464-7815
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026986A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
142980Medicare ID - Type Unspecified
INB29258Medicare UPIN