MEDICARE: DR. LORENZO D SOMMA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	01077633A	IN

General Provider Information

NPI Number	:	1205240710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORENZO D SOMMA MD

Provider Business Mailing Address
First Line	:	10330 N MERIDIAN ST # 300
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46290-1024
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 W DEERFIELD RD
Second Line	:
City	:	UNION CITY
State	:	IN
Zip	:	47390-1039
Country	:	US
Telephone Number	:	765-964-6200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2014
Last Update Date	:	01/20/2017

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