Provider Demographics
NPI:1770798340
Name:LORENZ, KATHRYN E (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:LORENZ
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 1:450 N HYATT ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-1433
Mailing Address - Country:US
Mailing Address - Phone:937-669-9978
Mailing Address - Fax:
Practice Address - Street 1:450 N HYATT ST
Practice Address - Street 2:SUITE 202
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-1433
Practice Address - Country:US
Practice Address - Phone:937-669-9978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.092562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2997262Medicaid
OH4282792Medicare PIN