Provider Demographics
NPI:1528089034
Name:LENZ, DAVID JUDE (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JUDE
Last Name:LENZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W3395 APPALOOSA CT
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8076
Mailing Address - Country:US
Mailing Address - Phone:920-739-1323
Mailing Address - Fax:
Practice Address - Street 1:W3395 APPALOOSA CT
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:WI
Practice Address - Zip Code:54913-8076
Practice Address - Country:US
Practice Address - Phone:920-739-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25979207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB54536Medicare UPIN
WI4532DMedicare ID - Type Unspecified