Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101014290 | MI |
NPI | 1609825645 |
---|---|
Provider Name | Dr. Lori A. Dillard |
First Address | Macomb, MI 48044-5024 |
Second Address | Macomb, MI 48044 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 12/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4435928 | (05) | MI |
H73381 | (02) | MI |