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Individual

MICHAEL LOCKWOOD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2600 FERRY ST, LAFAYETTE, IN 47904-3055
(765) 448-8000
(765) 448-7634
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621

Taxonomy

Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
01032816A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000189264
ANTHEM PROVIDER NUMBER
IN
05
100087340
IN
01
10825500
CAQH NUMBER
IN
01
9397233
PHCS PID NUMBER
IN
05
LO156012011
IN
Enumeration date
03/16/2006
Last updated
01/25/2021
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