Individual
DR. LORI L. CHECKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
17231 WILSHIRE DR, SOUTH BEND, IN 46635-2068
(269) 445-7295
Mailing address
17231 WILSHIRE DR, SOUTH BEND, IN 46635-2068
(269) 445-7295
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01069750A
IN
207Q00000X
Family Medicine Physician
4301082974
MI
207QA0401X
Addiction Medicine (Family Medicine) Physician
01069750A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100325680
—
IN
05
—
104736609
—
MI
01
—
169380005
MEDICARE
IN
01
—
236040010
MEDICARE
IN
Enumeration date
05/24/2005
Last updated
08/27/2022
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