Provider Demographics
NPI:1780777177
Name:PORTER, LULA G (MD)
Entity type:Individual
Prefix:MRS
First Name:LULA
Middle Name:G
Last Name:PORTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LULA
Other - Middle Name:G
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4666 RADNOR ROAD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-2154
Mailing Address - Country:US
Mailing Address - Phone:317-547-7669
Mailing Address - Fax:317-240-4357
Practice Address - Street 1:4666 RADNOR ROAD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-2154
Practice Address - Country:US
Practice Address - Phone:317-547-7669
Practice Address - Fax:317-240-4357
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01019700A207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20032340Medicaid
IN20032340Medicaid