Provider Demographics
NPI:1982664082
Name:MILLER, LORI L (DO)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 COLONIAL CIR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORWALK
Mailing Address - State:IA
Mailing Address - Zip Code:50211-9637
Mailing Address - Country:US
Mailing Address - Phone:515-285-3200
Mailing Address - Fax:515-285-3232
Practice Address - Street 1:800 COLONIAL CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:NORWALK
Practice Address - State:IA
Practice Address - Zip Code:50211-9637
Practice Address - Country:US
Practice Address - Phone:515-285-3200
Practice Address - Fax:515-285-3232
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1982664082Medicaid
IA3187385Medicaid
IA3187385Medicaid
IA080159556Medicare PIN
IAG57439Medicare UPIN
IA719260391Medicare PIN