Lori Fedoronko M D P C

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

LF064064 Issued in MI

Legal business name

LORI FEDORONKO M D P C

Practice address

1350 Kirts Blvd
Suite 155
Troy, MI 48084-4851

Phone

(248) 362-0222

NPI assigned

May 29, 2007

Organization subpart

No

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

Authorized official

Name

Lori Fedoronko, M DNPI 1548250855

Title

President

Phone

(248) 362-0222

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lori Marcum Fedoronko

  • Dermatology Physician
  • Troy, MI
  • NPI 1548250855
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467331200000",
    "number": "1265633416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 KIRTS BLVD",
            "address_2": "SUITE 155",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480844851",
            "telephone_number": "248-362-0222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 KIRTS BLVD",
            "address_2": "SUITE 155",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480844851",
            "telephone_number": "248-362-0222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LORI FEDORONKO M D P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-29",
        "last_updated": "2016-07-01",
        "status": "A",
        "authorized_official_last_name": "FEDORONKO",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-362-0222",
        "authorized_official_credential": "M D"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "MI",
            "license": "LF064064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3415994",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erika Lopez, LCSW
• Julia Nicole Lopez
• Nicole Lopiccolo
• Ciara Lopus, RDN
• Olivia Lord, PA-C
• Holly Erin Lorigan, D.O.
• Joseph Lorio, PHARMD
• Sophia Rose Loruss, LLMSW
• Sharon A Lotoczky, LMSW
• Olivia Loudermilk, LMSW

• Procedural Dermatology Physician in Troy, MI
• Providers in Troy, MI by specialty
• Procedural Dermatology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.