Healthcare Provider Details

I. General information

NPI: 1407960776
Provider Name (Legal Business Name): MICHAEL LEWIS LOREN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4963 NE GOODVIEW CIR SUITE A
LEES SUMMIT MO
64064-1998
US

IV. Provider business mailing address

10129 HEMLOCK DR
OVERLAND PARK KS
66212-3452
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-1500
  • Fax: 816-478-3413
Mailing address:
  • Phone: 913-649-5152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberR2A06
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: