Provider Demographics
NPI:1710989363
Name:LORELLI, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LORELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:18001 E 10 MILE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-3803
Mailing Address - Country:US
Mailing Address - Phone:586-247-4300
Mailing Address - Fax:313-432-2935
Practice Address - Street 1:22201 MOROSS RD
Practice Address - Street 2:SUITE 170
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2169
Practice Address - Country:US
Practice Address - Phone:586-247-4300
Practice Address - Fax:586-532-6496
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2017-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIDL0658292086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H63330Medicare UPIN
0H26358 027Medicare ID - Type Unspecified