Provider Demographics
NPI:1174507172
Name:DUNCAN, LORI SUE (DPM)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:SUE
Last Name:DUNCAN
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 1:18161 W 13 MILE RD
Mailing Address - Street 2:#D2
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1113
Mailing Address - Country:US
Mailing Address - Phone:248-258-0001
Mailing Address - Fax:248-258-6779
Practice Address - Street 1:18161 W 13 MILE RD
Practice Address - Street 2:#D2
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-1113
Practice Address - Country:US
Practice Address - Phone:248-258-0001
Practice Address - Fax:248-258-6779
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILD002091213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4687818Medicaid
U91255Medicare UPIN
MIF36404018Medicare ID - Type Unspecified