Healthcare Provider Details

I. General information

NPI: 1972040764
Provider Name (Legal Business Name): LO OTOLARYNGOLOGY AND FACIAL PASTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9660 E 146TH ST STE 100
NOBLESVILLE IN
46060-3097
US

IV. Provider business mailing address

9660 E 146TH ST STE 100
NOBLESVILLE IN
46060-3097
US

V. Phone/Fax

Practice location:
  • Phone: 317-773-6677
  • Fax:
Mailing address:
  • Phone: 317-773-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01074737A
License Number StateIN

VIII. Authorized Official

Name: EMILY JOAN-YING LO
Title or Position: PRESIDENT
Credential: MD
Phone: 317-773-6677