Provider Demographics
NPI:1356376743
Name:LORETZ, LILLIAN MACHELLE (DPM)
Entity type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:MACHELLE
Last Name:LORETZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:LILLIAN
Other - Middle Name:MACHELLE
Other - Last Name:LORETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:6709 WATERS WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2717
Mailing Address - Country:US
Mailing Address - Phone:912-777-3164
Mailing Address - Fax:912-777-3165
Practice Address - Street 1:6709 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2717
Practice Address - Country:US
Practice Address - Phone:912-777-3164
Practice Address - Fax:912-777-3165
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000860213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000817242CMedicaid
GA5691140001Medicare NSC
GA48SCCTNMedicare PIN
GA000817242CMedicaid