Provider Demographics
NPI:1154306124
Name:WELLS, LORI J (MD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:J
Last Name:WELLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:J
Other - Last Name:MOSEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5901 TECHNOLOGY CENTER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-6013
Mailing Address - Country:US
Mailing Address - Phone:317-328-5050
Mailing Address - Fax:317-715-9965
Practice Address - Street 1:5901 TECHNOLOGY CENTER DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-6013
Practice Address - Country:US
Practice Address - Phone:317-328-5050
Practice Address - Fax:317-715-9965
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039309A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000082130OtherANTHEM-351158723
IN000000492369OtherANTHEM 203778927
IN300100887OtherRR MEDICARE-351158723
IN100218850Medicaid
IN005570OtherSIHO-351158723
IN052995OtherHEALTH ALLIANCE-351158723
IN071706OtherHEALTH ALLIANCE-352047427
IN000000093035OtherANTHEM-352047427
IN002391OtherSIHO-352047427
IN300092225OtherRR MEDICARE-352047427
INQ0084714OtherCMOSHO351158723&352047427
IN005570OtherSIHO-351158723
IN300100887OtherRR MEDICARE-351158723
INE94283Medicare UPIN