Healthcare Provider Details

I. General information

NPI: 1952502452
Provider Name (Legal Business Name): MELISSA SUE LORA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 W BELLA DR
MARION IN
46953-5250
US

IV. Provider business mailing address

1411 W BELLA DR
MARION IN
46953-5250
US

V. Phone/Fax

Practice location:
  • Phone: 765-651-6637
  • Fax: 765-651-6639
Mailing address:
  • Phone: 765-651-6637
  • Fax: 765-651-6639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1066345A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: