Provider Demographics
NPI:1174522783
Name:LANKOWICZ, GENEVIEVE A (MD)
Entity type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:A
Last Name:LANKOWICZ
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:PO BOX 660376
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46266-0376
Mailing Address - Country:US
Mailing Address - Phone:574-523-3148
Mailing Address - Fax:574-523-3492
Practice Address - Street 1:600 EAST BLVD
Practice Address - Street 2:WEST WING
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2483
Practice Address - Country:US
Practice Address - Phone:574-523-2751
Practice Address - Fax:574-389-4840
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054719A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000725535OtherANTHEM BCBS - FMC
IN000000202811OtherANTHEM BCBS #
IN000000526016OtherANTHEM BCBS #
IN200356850AMedicaid
IN193390IMedicare PIN
080172716 RR MED #Medicare PIN
IN000000202811OtherANTHEM BCBS #
G52724Medicare UPIN