Provider Demographics
NPI:1689070310
Name:HABERMEHL, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:HABERMEHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 FLOWERY BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-5548
Mailing Address - Country:US
Mailing Address - Phone:317-417-8061
Mailing Address - Fax:317-215-0231
Practice Address - Street 1:9465 COUNSELORS ROW
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-6423
Practice Address - Country:US
Practice Address - Phone:317-417-6081
Practice Address - Fax:317-215-0231
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver