Provider Demographics
NPI:1992035299
Name:VORLICKY, LOREN N (MD)
Entity type:Individual
Prefix:
First Name:LOREN
Middle Name:N
Last Name:VORLICKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:CABLE
Mailing Address - State:WI
Mailing Address - Zip Code:54821-0130
Mailing Address - Country:US
Mailing Address - Phone:715-798-3124
Mailing Address - Fax:715-798-3341
Practice Address - Street 1:43570 KAVANAUGH RD
Practice Address - Street 2:
Practice Address - City:CABLE
Practice Address - State:WI
Practice Address - Zip Code:54821-4947
Practice Address - Country:US
Practice Address - Phone:715-798-3124
Practice Address - Fax:715-798-3341
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13850-20208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
A95883Medicare UPIN