MEDICARE: DR. LOWELL GREY SENSINTAFFAR 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	036-105071	IL

General Provider Information

NPI Number	:	1487649067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOWELL GREY SENSINTAFFAR M.D.

Provider Business Mailing Address
First Line	:	1116 HARTMAN LN
Second Line	:
City	:	SHILOH
State	:	IL
Zip	:	62221-7921
Country	:	US
Telephone Number	:	618-641-9011
Fax Number	:	618-641-9017

Provider Business Practice Location Address
First Line	:	1116 HARTMAN LN
Second Line	:
City	:	SHILOH
State	:	IL
Zip	:	62221-7921
Country	:	US
Telephone Number	:	618-641-9011
Fax Number	:	618-641-9017

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	01/05/2022

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