Provider Demographics
NPI:1982779153
Name:LAMB, CHARLES (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:LAMB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:707 NO MICHIGAN STREET
Mailing Address - Street 2:SUITE 501
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601
Mailing Address - Country:US
Mailing Address - Phone:574-237-0644
Mailing Address - Fax:574-234-6986
Practice Address - Street 1:707 NO MICHIGAN STREET
Practice Address - Street 2:SUITE 501
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601
Practice Address - Country:US
Practice Address - Phone:574-237-0644
Practice Address - Fax:574-234-6986
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01038463208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100367540AMedicaid
162710FMedicare ID - Type Unspecified
IN100367540AMedicaid