Basic Information
| Provider Information | |||||||||
| NPI: | 1659348837 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LALLI | ||||||||
| FirstName: | LORENZO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26908 DETROIT RD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | WESTLAKE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441452398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4406171823 | ||||||||
| FaxNumber: | 4406170884 | ||||||||
| Practice Location | |||||||||
| Address1: | 18099 LORAIN AVE | ||||||||
| Address2: | STE 312 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2169410066 | ||||||||
| FaxNumber: | 2169413667 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 08/18/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35055703L | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1780634279 | 01 | GROUP NPI | OTHER | 0715588 | 05 | OH | MEDICAID | 102746 | 01 | KAISER | OTHER | CA4511 | 01 | RR MEDICARE GROUP | OTHER | D368301 | 01 | GROUP IND DIAGNOSTICS MED | OTHER | 10794639 | 01 | CAQH | OTHER | P00039952 | 01 | RR MEDICARE INDIVIDUAL | OTHER | 0119204 | 01 | GROUP MEDICAID | OTHER | 9273172 | 01 | GROUP MEDICARE | OTHER | 3610861 | 01 | GROUP ASC MEDICARE | OTHER |