MEDICARE: MS. LORI LYNN RADNER L.L.P.

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	103T00000X	Psychologist	6301014878	MI

General Provider Information

NPI Number	:	1407050032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORI LYNN RADNER L.L.P.

Provider Business Mailing Address
First Line	:	37899 W 12 MILE RD STE 250
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-6107
Country	:	US
Telephone Number	:	248-788-6400
Fax Number	:	248-788-3840

Provider Business Practice Location Address
First Line	:	37899 W 12 MILE RD STE 250
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-6107
Country	:	US
Telephone Number	:	248-788-6400
Fax Number	:	248-788-3840

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

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	09/30/2019

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