Individual
LORELLE MICHELLE MANION
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1305 N BARKER RD STE 1, BROOKFIELD, WI 53045-5216
(262) 784-3200
(262) 784-8198
Mailing address
PO BOX 5005, WAUKESHA, WI 53187-5005
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35609
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32207500
—
WI
01
—
35609
WISCONSIN STATE LICENSE
WI
Enumeration date
05/17/2007
Last updated
04/19/2023
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