Individual
FAUSTO R. LORA-MIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2023 ROYAL BLVD, SUITE A, ELGIN, IL 60120
(847) 931-7274
(847) 931-7159
Mailing address
2023 ROYAL BLVD, SUITE A, ELGIN, IL 60120
(847) 931-7274
(847) 931-7159
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
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