Provider Demographics
NPI:1659348837
Name:LALLI, LORENZO (MD)
Entity Type:Individual
Prefix:
First Name:LORENZO
Middle Name:
Last Name:LALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26908 DETROIT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2398
Mailing Address - Country:US
Mailing Address - Phone:440-617-1823
Mailing Address - Fax:440-617-0884
Practice Address - Street 1:18099 LORAIN AVE
Practice Address - Street 2:STE 312
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111
Practice Address - Country:US
Practice Address - Phone:216-941-0066
Practice Address - Fax:216-941-3667
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055703L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1780634279OtherGROUP NPI
OH0715588Medicaid
102746OtherKAISER
CA4511OtherRR MEDICARE GROUP
D368301OtherGROUP IND DIAGNOSTICS MED
10794639OtherCAQH
P00039952OtherRR MEDICARE INDIVIDUAL
0119204OtherGROUP MEDICAID
9273172OtherGROUP MEDICARE
3610861OtherGROUP ASC MEDICARE
9273172OtherGROUP MEDICARE
CA4511OtherRR MEDICARE GROUP
OH4292471Medicare PIN
34-1783789OtherGROUP TIN