Provider Demographics
NPI:1275758955
Name:FLORO, LOURDES D (MD)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:D
Last Name:FLORO
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 1:5423 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3789
Mailing Address - Country:US
Mailing Address - Phone:708-422-4848
Mailing Address - Fax:708-422-7342
Practice Address - Street 1:5423 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3789
Practice Address - Country:US
Practice Address - Phone:708-422-4848
Practice Address - Fax:708-422-7342
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21603560OtherBCBS
IL21603560OtherBCBS
ILD93826Medicare UPIN