Basic Information
| Provider Information | |||||||||
| NPI: | 1316934102 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEKAREK | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 W WHITE RIVER BLVD | ||||||||
| Address2: | |||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473034988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8776685621 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 253 SAGAMORE PKWY W | ||||||||
| Address2: | |||||||||
| City: | WEST LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479061501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654488000 | ||||||||
| FaxNumber: | 7654467023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 02/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01059463A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 208D00000X | 01059463A | IN | N | Allopathic & Osteopathic Physicians | General Practice | 207P00000X | 01059463A | IN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000677223 | 01 | IN | ANTHEM PIN / ARNETT CLINIC, LLC URGENT CARE | OTHER | 000000342498 | 01 | ANTHEM BLUE CROSS BLUE SH | OTHER | 000000544391 | 01 | IN | ANTHEM PIN FOR ARNETT | OTHER | 200884370 | 05 | IN | MEDICAID | 92631 | 01 | GEISINGER HEALTH PLAN | OTHER | 9292098 | 01 | IN | AETNA PROVIDER NUMBER | OTHER |