Provider Demographics
NPI:1144216508
Name:DEBLASI, LORI MARIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:MARIE
Last Name:DEBLASI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 GOODLETTE RD
Mailing Address - Street 2:STE 102
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5617
Mailing Address - Country:US
Mailing Address - Phone:239-430-3668
Mailing Address - Fax:239-692-9436
Practice Address - Street 1:1645 COLONIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1101
Practice Address - Country:US
Practice Address - Phone:239-430-3668
Practice Address - Fax:239-692-9436
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4222213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPD6416Medicaid
OH10790442OtherCAQH
OH2215481Medicaid
SC641OtherSC MEDICAL LICENSE
OH4123294Medicare PIN
OH2215481Medicaid
SCPD6416Medicaid
SCSC57777153Medicare PIN