Provider Demographics
NPI:1770523524
Name:READ, LORY MICHELLE (DO)
Entity type:Individual
Prefix:
First Name:LORY
Middle Name:MICHELLE
Last Name:READ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3700 52ND ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-9637
Mailing Address - Country:US
Mailing Address - Phone:616-656-3700
Mailing Address - Fax:616-656-0898
Practice Address - Street 1:418 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:MI
Practice Address - Zip Code:48850-9806
Practice Address - Country:US
Practice Address - Phone:989-352-6474
Practice Address - Fax:989-352-8451
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MILR015790OtherBCBS
MI4913900Medicaid
MII59586Medicare UPIN
MI0E46007012Medicare PIN
MI233869Medicare PIN