Individual
FAUSTO R. LORA-MIR
Active
Individual
FAUSTO R. LORA-MIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036084051
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00001384212 18
UNITED HEALTHCARE
IL
01
—
0005767635
AETNA
IL
01
—
0163557
BLUE CROSS
IL
05
—
036084051
—
IL
Enumeration date
05/05/2006
Last updated
10/03/2008
Update your record
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