Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | R2A06 | MO |
NPI | 1407960776 |
---|---|
Provider Name | Michael Lewis Loren |
First Address | Overland Park, KS 66212-3452 |
Second Address | Lees Summit, MO 64064-1998 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08334038 | BC/BS OF KANSAS CITY (01) | MO |
C50394 | (02) | MO |