Lori A Heinrich, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

29744-020 Issued in WI

Practice address

10303 N Port Washington Rd
Suite 101
Mequon, WI 53092-5760

Phone

(262) 240-0440

Fax

(262) 240-0441

NPI assigned

Oct 4, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Lori A Nelson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• North Shore Dermatology, S.C.

  • Dermatology Physician
  • Mequon, WI
  • NPI 1649399080
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184803200000",
    "number": "1184719288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10303 N PORT WASHINGTON RD",
            "address_2": "SUITE 101",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925760",
            "telephone_number": "262-240-0440",
            "fax_number": "262-240-0441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10303 N PORT WASHINGTON RD",
            "address_2": "SUITE 101",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925760",
            "telephone_number": "262-240-0440",
            "fax_number": "262-240-0441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEINRICH",
        "first_name": "LORI",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WI",
            "license": "29744-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31824000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LORI",
            "last_name": "NELSON",
            "middle_name": "A",
            "prefix": "MS.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Dermatology Physician in Mequon, WI
• Providers in Mequon, WI by specialty
• Dermatology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.