Healthcare Provider Details

I. General information

NPI: 1558365981
Provider Name (Legal Business Name): PAUL WILLON LOEWENSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 W NORTH AVENUE SUITE 110
BROOKFIELD WI
53005
US

IV. Provider business mailing address

13800 W NORTH AVENUE SUITE 110
BROOKFIELD WI
53005
US

V. Phone/Fax

Practice location:
  • Phone: 262-717-4000
  • Fax: 262-641-7435
Mailing address:
  • Phone: 262-717-4000
  • Fax: 262-641-7435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number24569
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number24569
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: