Healthcare Provider Details

I. General information

NPI: 1336550748
Provider Name (Legal Business Name): LOREN R KAISER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LOREN R. MUELLER

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MEDICAL PARK SUITE 221
WHEELING WV
26003
US

IV. Provider business mailing address

1 MEDICAL PARK PHYSICIAN BILLING DEPT. NTTC
WHEELING WV
26003
US

V. Phone/Fax

Practice location:
  • Phone: 304-243-8850
  • Fax: 304-243-8437
Mailing address:
  • Phone: 304-243-7181
  • Fax: 304-243-1131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number27088
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: