Organization
LINCOLN PEDIC CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JANET ALYCE PAUNWAR (PRESIDENT)
(260) 637-8414
Entity
Organization
Contact information
Practice address
12311 AUTUMN BREEZE DR, FORT WAYNE, IN 46845-9111
(260) 637-8414
(260) 637-8152
Mailing address
12311 AUTUMN BREEZE DR, FORT WAYNE, IN 46845-9111
(260) 637-8414
(260) 637-8152
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07000776A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000235683
ANTHEM BLUE CROSS
IN
05
—
100210380A
—
IN
01
—
C31367
PALMETTO GBA
IN
Enumeration date
06/10/2005
Last updated
11/30/2010
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