Provider Demographics
NPI:1710100425
Name:LORENZ, GRETCHEN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:MARIE
Last Name:LORENZ
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 1:9159 N COUNTY ROAD 25A
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-9521
Mailing Address - Country:US
Mailing Address - Phone:937-773-8221
Mailing Address - Fax:937-773-5117
Practice Address - Street 1:9159N COUNTY RD 25A
Practice Address - Street 2:PIQUA FAMILY PRACTICE
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356
Practice Address - Country:US
Practice Address - Phone:937-773-8221
Practice Address - Fax:937-773-5117
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.089110207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2002317Medicaid
OH2002317Medicaid
OHOTH000Medicare UPIN