Physician Compare National (NPI:1548250855)

HEALTHCARE PROVIDER: DR. LORI MARCUM FEDORONKO

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1548250855
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6709966351
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080108000704
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FEDORONKO
	Individual professional last name
Provider First Name	LORI
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1991
	Individual professional's medical school graduation year
Primary Specialty	DERMATOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1350 KIRTS BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 155
	Group Practice or individual's line 2 address
City	TROY
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	480844854
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y