Individual
LENNON WALLACE GREGOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 W MICHIGAN ST # CL630, INDIANAPOLIS, IN 46202-5209
(317) 274-2686
Mailing address
1120 W MICHIGAN ST # CL630, INDIANAPOLIS, IN 46202-5209
(317) 274-2686
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01096556A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
IN
Other
Enumeration date
04/03/2022
Last updated
08/18/2025
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