Individual
LORI W WANKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
5165 MCCARTY LN, LAFAYETTE, IN 47905-8764
(765) 448-8000
(765) 838-6351
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
02005809A
IN
207RN0300X
Nephrology Physician
Primary
02005809A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300032698
—
IN
01
—
815500545
MEDICARE PTAN
IN
Enumeration date
04/01/2013
Last updated
11/07/2023
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