Provider Demographics
NPI:1770585317
Name:DEEMER, LORI A (MD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:A
Last Name:DEEMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:HURST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:ONE MEMORIAL SQUARE
Mailing Address - Street 2:SUITE 50
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-1357
Mailing Address - Country:US
Mailing Address - Phone:317-468-6257
Mailing Address - Fax:317-468-6268
Practice Address - Street 1:120 W MCKENZIE RD STE H
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1072
Practice Address - Country:US
Practice Address - Phone:317-462-2335
Practice Address - Fax:317-462-2069
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058228A207QB0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00262219OtherMEDICARE RAILROAD#
IN200478180Medicaid
IN20311740OtherMEDICAID GROUP#
IN7217665OtherAETNA PIN#
IN000000369484OtherANTHEM PIN#
IN20311740OtherMEDICAID GROUP#
IN200478180Medicaid