Individual
MRS. STEPHANIE N LORTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4804 SOUTH STATE ROUTE 159, GLEN CARBON, IL 62034
(618) 288-9305
(618) 288-9308
Mailing address
4804 SOUTH STATE ROUTE 159, GLEN CARBON, IL 62034
(618) 288-9305
(618) 288-9308
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036146838
IL
208000000X
Pediatrics Physician
2015017245
MO
Other
Enumeration date
06/13/2015
Last updated
08/31/2018
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