MEDICARE: DR. KAE B LOVERINK M.D.

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
1	207Q00000X	Family Medicine Physician	35537	CO
2	207Q00000X	Family Medicine Physician	MD159669	OR

Other Identifiers

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

General Provider Information

NPI Number	:	1467418681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAE B LOVERINK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 5723
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97708-5723
Country	:	US
Telephone Number	:	702-453-3799
Fax Number	:	702-453-5741

Provider Business Practice Location Address
First Line	:	1900 SUNRISE DR
Second Line	:
City	:	SAINT PETER
State	:	MN
Zip	:	56082-5376
Country	:	US
Telephone Number	:	507-934-7312
Fax Number	:	507-934-8516

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	03/17/2018

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