Individual
MR. LONNIE D ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
19816 ADAMS RD, SOUTH BEND, IN 46637-1620
(574) 273-2343
(574) 272-4752
Mailing address
19816 ADAMS RD, SOUTH BEND, IN 46637
(574) 273-2343
(574) 272-4752
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200888720A
—
IN
Enumeration date
12/19/2008
Last updated
12/19/2008
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