Healthcare Provider Details

I. General information

NPI: 1770585317
Provider Name (Legal Business Name): LORI A DEEMER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI A HURST M.D.

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W MCKENZIE RD STE H
GREENFIELD IN
46140-1072
US

IV. Provider business mailing address

ONE MEMORIAL SQUARE SUITE 50
GREENFIELD IN
46140-1357
US

V. Phone/Fax

Practice location:
  • Phone: 317-462-2335
  • Fax: 317-462-2069
Mailing address:
  • Phone: 317-468-6257
  • Fax: 317-468-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number01058228A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01058228A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: