Individual
DR. LUCILLE E KANJER-LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
205 N TILLOTSON AVE, MUNCIE, IN 47304-3900
(765) 291-5437
(765) 284-5387
Mailing address
205 N TILLOTSON AVE, MUNCIE, IN 47304-3900
(765) 291-5437
(978) 878-8498
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01092632A
IN
208000000X
Pediatrics Physician
161078
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3199738
—
MA
Enumeration date
11/15/2005
Last updated
05/14/2024
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