Provider Demographics
NPI:1952356164
Name:LEFRANC, MADELYN G (MD)
Entity Type:Individual
Prefix:
First Name:MADELYN
Middle Name:G
Last Name:LEFRANC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 ST FRANCIS WAY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4923
Mailing Address - Country:US
Mailing Address - Phone:765-446-4819
Mailing Address - Fax:765-446-4859
Practice Address - Street 1:1701 S CREASY LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4972
Practice Address - Country:US
Practice Address - Phone:765-446-4819
Practice Address - Fax:765-446-4859
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350824102085R0202X
IN01062170A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000518923OtherANTHEM
IN200824060Medicaid
OH2407238Medicaid
P00044119OtherMEDICARE RAILROAD
INP00414330OtherMEDICARE RR
OH2407238Medicaid
IN000000518923OtherANTHEM
H89538Medicare UPIN