Healthcare Provider Details

I. General information

NPI: 1316148273
Provider Name (Legal Business Name): LORI L MCALLISTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORI LAVON FRASER M.D.

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 11/17/2024
Certification Date: 11/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-6000
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number51016
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: