Provider Demographics
NPI:1730118944
Name:LOZANO, JULIO R (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:R
Last Name:LOZANO
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 1:2060 N SHADELAND AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-1762
Mailing Address - Country:US
Mailing Address - Phone:317-635-3499
Mailing Address - Fax:317-635-0449
Practice Address - Street 1:2060 N SHADELAND AVE
Practice Address - Street 2:STE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1762
Practice Address - Country:US
Practice Address - Phone:317-635-3499
Practice Address - Fax:317-635-0449
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058425A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200881920Medicaid
IN941780AAAAMedicare ID - Type UnspecifiedMEDICARE B PROVIDER #
IN200881920Medicaid