Provider Demographics
NPI:1669923561
Name:PUMA, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:PUMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28398 MORTENVIEW
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-5031
Mailing Address - Country:US
Mailing Address - Phone:313-510-1875
Mailing Address - Fax:
Practice Address - Street 1:28398 MORTENVIEW
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-5031
Practice Address - Country:US
Practice Address - Phone:313-510-1875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other