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NPI Code Detail

MEDICARE: SHANNON L LOECK MD

MEDICARE:   SHANNON L LOECK  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician94-08890KS
22255A2300XAthletic Trainer000164CT
32084P0800XPsychiatry Physician04-43063KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356478762
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON L LOECK MD
Provider Business Mailing Address
First Line : 1010 N KANSAS ST
Second Line :
City : WICHITA
State : KS
Zip : 67214-3124
Country : US
Telephone Number : 316-293-2665
Fax Number :
Provider Business Practice Location Address
First Line : 1001 N MINNEAPOLIS ST
Second Line :
City : WICHITA
State : KS
Zip : 67214-3127
Country : US
Telephone Number : 316-293-2647
Fax Number : 855-476-0305
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2007
Last Update Date : 06/19/2023

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Directions to “ SHANNON L LOECK MD” Practice Location

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