Provider Demographics
NPI:1295771582
Name:LORENZ, FREDERICK S (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:S
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 1:310 N L ROGERS WELLS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-1300
Mailing Address - Country:US
Mailing Address - Phone:270-659-5885
Mailing Address - Fax:270-659-5852
Practice Address - Street 1:310 N L ROGERS WELLS BLVD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1300
Practice Address - Country:US
Practice Address - Phone:270-659-5885
Practice Address - Fax:270-659-5852
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47589207Y00000X
OH35084750207Y00000X
MO2020038084207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100344950Medicaid
KYK101930Medicare PIN
341407259OtherCIGNA
LO4141752OtherTRICARE
341407259OtherNATIONWIDE
B86056Medicare UPIN
OH2507782Medicaid
31407259OtherUHC