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General NPI Number Information
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NPI Number | 1619204187
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Entity Type | Organization
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Legal Business Name | DR. LORI PC
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Dates
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Enumeration Date | 11/04/2009
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Last Update Date | 11/04/2009
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Provider Practice Location Address
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Address Line | 353 SOUTH OLD WOODWARD AVE
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City | BIRMINGHAM
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State | MI
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Zip | 48009
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Country | US
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Telephone | 248-645-0830
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Fax | 248-645-2863
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Provider Business Mailing Address
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Address Line | 5312 CAPRI
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City | TROY
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State | MI
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Zip | 48098
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Country | US
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Telephone | 248-645-0830
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Fax | 248-645-2863
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | LORI HADDAD
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Credential | D.O.
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Telephone | 248-645-0830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | LH010584
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License Number State | MI
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