Provider Demographics
NPI:1144214073
Name:WENZEL, LORI S (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:S
Last Name:WENZEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-337-3193
Mailing Address - Fax:319-545-4570
Practice Address - Street 1:2769 HEARTLAND DR STE 201
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2732
Practice Address - Country:US
Practice Address - Phone:319-337-3193
Practice Address - Fax:319-545-4570
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-30352207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA160026347OtherRAILROAD
IA28139OtherBC/BS
IA0121673Medicaid
IA28139OtherBC/BS
IAG01370Medicare UPIN
IA0121673Medicaid