Healthcare Provider Details

I. General information

NPI: 1184608135
Provider Name (Legal Business Name): ARTHUR W. LOESEVITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 IRELAND AVE
FORT KNOX KY
40121-2722
US

IV. Provider business mailing address

611 FOXFIRE RD
ELIZABETHTOWN KY
42701-9412
US

V. Phone/Fax

Practice location:
  • Phone: 502-624-9423
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number38648
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: