Provider Demographics
NPI:1174207872
Name:SLEMKER, TRACY (CPO LPO)
Entity type:Individual
Prefix:MR
First Name:TRACY
Middle Name:
Last Name:SLEMKER
Suffix:
Gender:M
Credentials:CPO LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 CHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1214
Mailing Address - Country:US
Mailing Address - Phone:765-756-5014
Mailing Address - Fax:765-488-1165
Practice Address - Street 1:2011 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1214
Practice Address - Country:US
Practice Address - Phone:765-756-5014
Practice Address - Fax:765-488-1165
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH114224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty