Provider Demographics
NPI:1952311599
Name:SHELDON, LORI ANN (DPM)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:SHELDON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 DEXTER RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2702
Mailing Address - Country:US
Mailing Address - Phone:734-994-9111
Mailing Address - Fax:734-994-4410
Practice Address - Street 1:2550 DEXTER RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-2702
Practice Address - Country:US
Practice Address - Phone:734-994-9111
Practice Address - Fax:734-994-4410
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002011213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4858150120OtherBLUE TRADITIONAL & TRUST
MI480H16064OtherBLUE CROSS BLUE SHIELD
MI0N16720Medicare ID - Type Unspecified
MI4858150120OtherBLUE TRADITIONAL & TRUST
MIU77411Medicare UPIN