MEDICARE: BETH DENENBERG LOWE 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
1	208000000X	Pediatrics Physician	4301407065	MI

General Provider Information

NPI Number	:	1487634440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH DENENBERG LOWE MD

Provider Business Mailing Address
First Line	:	5095 LAKE BLUFF RD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-2430
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18181 OAKWOOD BLVD
Second Line	:	SUITE 101G
City	:	DEARBORN
State	:	MI
Zip	:	48124-5032
Country	:	US
Telephone Number	:	313-593-7240
Fax Number	:

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	07/08/2007

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