Healthcare Provider Details

I. General information

NPI: 1952562456
Provider Name (Legal Business Name): ABBY JO LOCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 W. 75TH STREET SUITE 220
MERRIAM KS
66204
US

IV. Provider business mailing address

8800 W. 75TH STREET SUITE 220
MERRIAM KS
66204
US

V. Phone/Fax

Practice location:
  • Phone: 913-384-5500
  • Fax: 913-384-5209
Mailing address:
  • Phone: 913-384-5500
  • Fax: 913-384-5209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2010011560
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-34904
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: