Provider Demographics
NPI:1790794451
Name:BROOKS, LORI L (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:L
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:L
Other - Last Name:VANKOEVERING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2500 W LAYTON AVE STE 40
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-5420
Mailing Address - Country:US
Mailing Address - Phone:262-577-0250
Mailing Address - Fax:262-577-0251
Practice Address - Street 1:2500 W LAYTON AVE STE 30
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-5436
Practice Address - Country:US
Practice Address - Phone:262-577-0250
Practice Address - Fax:262-577-0251
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32557208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32054100Medicaid
WI32054100Medicaid
BB2940181OtherDEA NUMBER
WIK400112169Medicare PIN