Individual
RUOLAN LORI PI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2421 LAPORTE AVE, VALPARAISO, IN 46383-6914
(219) 462-6192
(219) 464-2585
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01058396A
IN
208000000X
Pediatrics Physician
01058396A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000721924
ANTHEM TRADITIONAL
IN
05
—
200467920
—
IN
Enumeration date
08/29/2005
Last updated
08/22/2023
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