Healthcare Provider Details

I. General information

NPI: 1275692485
Provider Name (Legal Business Name): MICHAEL D. LORTON, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date: 03/04/2009
Reactivation Date: 03/19/2009

III. Provider practice location address

2467 WOODVILLE RD SUITE 1
OREGON OH
43616-3800
US

IV. Provider business mailing address

2467 WOODVILLE RD SUITE 1
OREGON OH
43616-3800
US

V. Phone/Fax

Practice location:
  • Phone: 419-698-9595
  • Fax: 419-698-9550
Mailing address:
  • Phone: 419-698-9595
  • Fax: 419-698-9550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL D. LORTON
Title or Position: PROVIDER-OWNER
Credential: M.D.
Phone: 419-698-9595