Individual
DR. WILLIAM CHARLES LENTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5750 FALLS DR, FORT WAYNE, IN 46804-7147
(260) 436-8000
(260) 432-5587
Mailing address
5750 FALLS DR, FORT WAYNE, IN 46804-7147
(260) 436-8000
(260) 432-5587
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01021532A
IN
207NS0135X
Procedural Dermatology Physician
01021532A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000308071
BCBS
—
01
—
01021532A
STATE LICENSE NUMBER
IN
01
—
01021532B
CSR LICENSE NUMBER
IN
05
—
100466080
—
IN
01
—
1517
PHP
—
01
—
4228241
AETNA
—
01
—
P00071324
MEDICARE RAILROAD
—
Enumeration date
09/24/2006
Last updated
03/07/2023
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