Provider Demographics
NPI:1629160965
Name:RILEY, LORI M (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:M
Last Name:RILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7244 S PAXTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-2520
Mailing Address - Country:US
Mailing Address - Phone:773-493-3887
Mailing Address - Fax:773-493-3105
Practice Address - Street 1:6020 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-2112
Practice Address - Country:US
Practice Address - Phone:773-488-9608
Practice Address - Fax:773-488-9605
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH47161Medicare UPIN