Healthcare Provider Details

I. General information

NPI: 1588867410
Provider Name (Legal Business Name): CLAUDIA MERCEDES LORA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S WOOD ST M/C 783
CHICAGO IL
60612-4325
US

IV. Provider business mailing address

820 S WOOD ST # MC793
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number36114539
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number336.080840
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: