Provider Demographics
NPI:1316902109
Name:SCALES, LORI M (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:M
Last Name:SCALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:M
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:300 HIGH POINT CT
Practice Address - Street 2:
Practice Address - City:MT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-6560
Practice Address - Country:US
Practice Address - Phone:502-955-6129
Practice Address - Fax:502-955-8161
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35852207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
50001529OtherPASSPORT / NMA
000000350676OtherANTHEM / NMA
023067OtherSIHO / NMA
000052154GOtherHUMANA / NMA
2443114000OtherPASSPORT ADVANTAGE / NMA
KY64067580Medicaid
1208710OtherCHA / NMA
5843355OtherCIGNA / NMA
KYP00176818OtherRAILROAD MEDICARE
KYP00176818OtherRAILROAD MEDICARE
KY0361938Medicare PIN