Provider Demographics
NPI:1386496289
Name:DI LORENZO, MICHAEL FRANK THOMAS III (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FRANK THOMAS
Last Name:DI LORENZO
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FRANK MICHAEL
Other - Middle Name:THOMAS
Other - Last Name:DI LORENZO
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:465 W PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3320
Mailing Address - Country:US
Mailing Address - Phone:916-342-5717
Mailing Address - Fax:
Practice Address - Street 1:465 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3320
Practice Address - Country:US
Practice Address - Phone:559-788-6156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program