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1508825290

NPI Code Detail

MEDICARE: KRYSTAL VANLOWE MD

MEDICARE: KRYSTAL VANLOWE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	4301074586	MI
2	207V00000X	Obstetrics & Gynecology Physician	0000351	CO
3	207V00000X	Obstetrics & Gynecology Physician	15864	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	700E012300	OTHER	MI	BCBSM GROUP NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	700H201530	OTHER	MI	BCBSM GROUP NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508825290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTAL VANLOWE MD

Provider Business Mailing Address
First Line	:	8906 SPANISH RIDGE AVE STE 202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1319
Country	:	US
Telephone Number	:	702-330-3102
Fax Number	:	702-912-4994

Provider Business Practice Location Address
First Line	:	8906 SPANISH RIDGE AVE STE 202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1319
Country	:	US
Telephone Number	:	702-577-1622
Fax Number	:	702-912-4994

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	07/09/2022

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Directions to “ KRYSTAL VANLOWE MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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