MEDICARE: LOREN L FAABORG 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	207VX0000X	Obstetrics Physician	13067	NE
2	207VG0400X	Gynecology Physician	33356	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04010	OTHER	NE	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659378479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOREN L FAABORG MD

Provider Business Mailing Address
First Line	:	13050 N 103RD AVE
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3011
Country	:	US
Telephone Number	:	623-547-2600
Fax Number	:	623-547-1899

Provider Business Practice Location Address
First Line	:	14044 W CAMELBACK RD
Second Line	:	SUITE 118
City	:	LITCHFIELD PARK
State	:	AZ
Zip	:	85340-9428
Country	:	US
Telephone Number	:	623-547-2600
Fax Number	:	623-547-1899

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	06/11/2015

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Directions to “ LOREN L FAABORG MD” Practice Location

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