Healthcare Provider Details

I. General information

NPI: 1962500827
Provider Name (Legal Business Name): KENNETH R LOVING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 S PARK ST
MADISON WI
53713-1916
US

IV. Provider business mailing address

2901 W. BELTLINE HWY. SUITE 120
MADISON WI
53713-4226
US

V. Phone/Fax

Practice location:
  • Phone: 608-443-5480
  • Fax:
Mailing address:
  • Phone: 608-443-5603
  • Fax: 608-441-1981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38254-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: