Provider Demographics
NPI:1740440841
Name:WHITIS, LORI JO (MD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:JO
Last Name:WHITIS
Suffix:
Gender:F
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:S5070 WILLIAM CT
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-5052
Mailing Address - Country:US
Mailing Address - Phone:715-552-5521
Mailing Address - Fax:
Practice Address - Street 1:836 RICHARD DR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6242
Practice Address - Country:US
Practice Address - Phone:715-839-8477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43892-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine