Provider Demographics
NPI:1801871694
Name:HIRSCHLER, LENORA R (MD)
Entity type:Individual
Prefix:
First Name:LENORA
Middle Name:R
Last Name:HIRSCHLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 S MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-5235
Mailing Address - Country:US
Mailing Address - Phone:574-533-8639
Mailing Address - Fax:
Practice Address - Street 1:2014 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-5235
Practice Address - Country:US
Practice Address - Phone:574-533-8639
Practice Address - Fax:574-534-9542
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060566A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200521450Medicaid
IN200521450Medicaid
IN000000570558OtherANTHEM
IN3937240020OtherMEDICARE DMEPOS
INP00266937OtherRAILROAD MEDICARE
7667677OtherAETNA
IN000000368892OtherANTHEM
IN138160OMedicare PIN
IN200521450Medicaid
IN069860KKKMedicare PIN
IN3937240020OtherMEDICARE DMEPOS