Individual
HEIDI M LAKANEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1809 S MAIN ST, UPLAND, IN 46989-9242
(765) 998-6200
Mailing address
1200 W. WHITE RIVER BLVD., RCS PROVIDER ENROLLMENT: ATTN-DAWN HAMAKER, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01044755
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200101500
—
IN
01
—
P00720113
RR MEDICARE PTAN
IN
01
—
P00968548
RR MEDICARE
IN
Enumeration date
02/23/2006
Last updated
01/22/2021
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