Healthcare Provider Details

I. General information

NPI: 1407845522
Provider Name (Legal Business Name): INGEBORG ANNA LOEWENSTEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11937 US HIGHWAY 271
TYLER TX
75708-3154
US

IV. Provider business mailing address

PO BOX 847824
DALLAS TX
75284-7824
US

V. Phone/Fax

Practice location:
  • Phone: 903-877-3451
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberJ9169
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: