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Individual

DR. JUSTIN RYAN LOCKREM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
900 N JOHN R WOODEN DR, WEST LAFAYETTE, IN 47907-2117
(765) 494-3245
(765) 494-9899
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01091015A
IN
207RS0010X
Sports Medicine (Internal Medicine) Physician
01091015A
IN
208000000X
Pediatrics Physician
01091015A
IN

Other

Enumeration date
05/22/2015
Last updated
09/26/2023
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