Provider Demographics
NPI:1184647836
Name:MEYER, LOREN MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:MARC
Last Name:MEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 HENSHAW
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173
Mailing Address - Country:US
Mailing Address - Phone:414-699-5742
Mailing Address - Fax:866-761-7823
Practice Address - Street 1:12503 WEDD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213
Practice Address - Country:US
Practice Address - Phone:414-699-5742
Practice Address - Fax:866-761-7823
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-35406208000000X
MO2011023185208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
B55063Medicare UPIN