Basic Information
| Provider Information | |||||||||
| NPI: | 1255383469 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LENZ | ||||||||
| FirstName: | WADE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1949 GUNBARREL RD STE 206 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374217133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234954345 | ||||||||
| FaxNumber: | 4234954934 | ||||||||
| Practice Location | |||||||||
| Address1: | 5600 BRAINERD RD STE A4 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374115336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232664588 | ||||||||
| FaxNumber: | 4233420103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 06/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD55948 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 070114 | 01 | HEALTH ALLIANCE | OTHER | 190471 | 01 | IOWA HEALTH SOLUTIONS | OTHER | 0241745 | 05 | IA | MEDICAID | IA0194 | 01 | JOHN DEERE HEALTH | OTHER | 235474 | 01 | MIDLANDS CHOICE | OTHER | 42938 | 01 | IA | WELLMARK BC/BS | OTHER |