Individual
LEE ALLEN HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2400 SOUTH ST., DEPARTMENT OF PATHOLOGY, LAFAYETTE, IN 47904
(765) 448-4319
(765) 448-2921
Mailing address
PO BOX 5628, LAFAYETTE, IN 47903-5628
(765) 448-4319
(765) 448-2921
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
1035929A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000315528
ANTHEM
IN
01
—
111890J
MEDICARE
IN
01
—
176600G
MEDICARE
IN
Enumeration date
06/27/2005
Last updated
07/16/2007
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