Basic Information
| Provider Information | |||||||||
| NPI: | 1497736714 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEHENBAUER | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 SMITH RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452122787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135331199 | ||||||||
| FaxNumber: | 5135336001 | ||||||||
| Practice Location | |||||||||
| Address1: | 7423 S MASON MONTGOMERY RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450407828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133983445 | ||||||||
| FaxNumber: | 5133984680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2005 | ||||||||
| LastUpdateDate: | 02/20/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35050209 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0562574 | 05 | OH | MEDICAID |