Healthcare Provider Details

I. General information

NPI: 1861620692
Provider Name (Legal Business Name): LOREN W HAVEMEIER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 PLEASANT ST STE 618
DES MOINES IA
50309-1418
US

IV. Provider business mailing address

7147 VISTA DR STE 150
WEST DES MOINES IA
50266-9317
US

V. Phone/Fax

Practice location:
  • Phone: 515-875-9090
  • Fax:
Mailing address:
  • Phone: 515-875-9255
  • Fax: 515-875-9223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002367
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2454
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: