Provider Demographics
NPI:1467516476
Name:KATZMAN, LORI A (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:A
Last Name:KATZMAN
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 1:14709 W UPRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1949
Mailing Address - Country:US
Mailing Address - Phone:231-547-1252
Mailing Address - Fax:231-547-8897
Practice Address - Street 1:14695 PARK AVE
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1920
Practice Address - Country:US
Practice Address - Phone:231-547-1252
Practice Address - Fax:231-547-8897
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010521182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4477169Medicaid
BK2236138OtherD.E.A. NUMBER
MI4477169Medicaid
N71130006Medicare ID - Type Unspecified