Provider Demographics
NPI:1437186863
Name:LOFWALL, MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LOFWALL
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 1:845 ANGLIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-3146
Mailing Address - Country:US
Mailing Address - Phone:859-323-9321
Mailing Address - Fax:859-257-5232
Practice Address - Street 1:845 ANGLIANA AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-3146
Practice Address - Country:US
Practice Address - Phone:859-323-9321
Practice Address - Fax:859-257-5232
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY399572084A0401X, 2084P0800X
MDD579132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405047900Medicaid
MD405047900Medicaid
MDI08056Medicare UPIN