Provider Demographics
NPI:1255418125
Name:LORENZ, LLOYD (MD)
Entity type:Individual
Prefix:
First Name:LLOYD
Middle Name:
Last Name:LORENZ
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 1:315 W OLD KEY DR
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-9057
Mailing Address - Country:US
Mailing Address - Phone:765-475-6963
Mailing Address - Fax:765-475-2833
Practice Address - Street 1:315 W OLD KEY DR
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-9057
Practice Address - Country:US
Practice Address - Phone:765-475-6963
Practice Address - Fax:765-475-2833
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040493207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100335260Medicaid
IN100335260Medicaid
080158182Medicare PIN
IN151520EMedicare PIN
IN100335260Medicaid