Provider Demographics
NPI:1154312726
Name:LOWRIE, LIA H (MD)
Entity Type:Individual
Prefix:
First Name:LIA
Middle Name:H
Last Name:LOWRIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1003
Mailing Address - Country:US
Mailing Address - Phone:314-577-5395
Mailing Address - Fax:314-268-6459
Practice Address - Street 1:1465 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1003
Practice Address - Country:US
Practice Address - Phone:314-577-5395
Practice Address - Fax:314-268-6459
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20110066012080P0203X, 2080P0203X
OH350515742080P0203X
OH35-0515742080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH647553OtherAETNA
OH000000221165OtherUNISON
OH727503OtherBUCKEYE
OH000000526045OtherANTHEM
SCQ51574Medicaid
OH0791237Medicaid
PA0016555070001Medicaid
OH0791237OtherBCMH
OH363783OtherWELLCARE
PA1016555070003OtherPA MEDICAID
MI1154312726OtherMI MEDICAID
OHP00618511OtherRAILROAD MEDICARE
OHP00618511OtherRAILROAD MEDICARE
OHLO0678754Medicare PIN