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NPI Code Detail

MEDICARE: GERALD R LOEWEN MA, LP

MEDICARE: GERALD R LOEWEN MA, LP
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
1103T00000XPsychologistLP3340MN

General Provider Information

NPI Number : 1427114834
Entity Type Code : Individual
Provider Name (Legal Business Name) : GERALD R LOEWEN MA, LP
Provider Business Mailing Address
First Line : 3125 3RD AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-3223
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4123 E LAKE ST
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55406-2255
Country : US
Telephone Number : 612-729-0340
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2006
Last Update Date : 09/05/2007

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