Basic Information
| Provider Information | |||||||||
| NPI: | 1386630838 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LENTZ | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 KIMOLE LN | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | ADRIAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492211478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172635655 | ||||||||
| FaxNumber: | 5172638012 | ||||||||
| Practice Location | |||||||||
| Address1: | 777 KIMOLE LN | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | ADRIAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492211478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172635655 | ||||||||
| FaxNumber: | 5172638012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301049176 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.