=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457300675
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL R LOEW MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2006
-----------------------------------------------------
Last Update Date | 08/03/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2222 N NEVADA AVE
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80907-6831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-766-5333
-----------------------------------------------------
Fax | 719-766-5651
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1241 W MINERAL AVE SUITE 100
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80120-5685
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-759-0854
-----------------------------------------------------
Fax | 303-759-0864
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 37162
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207PH0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Emergency Medicine) Physician
-----------------------------------------------------
License Number | 37162
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------