Individual
KENT T LANCASTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1411 S. CREASY LANE, SUITE 130, LAFAYETTE, IN 47905-7433
(765) 447-7447
(765) 807-0553
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 449-2732
(765) 449-1196
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301406274
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200933980
—
IN
05
—
2927880
—
MI
01
—
30001101191
BCBS
MI
Enumeration date
07/12/2006
Last updated
06/15/2020
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