Provider Demographics
NPI:1285672279
Name:VRANISH, LOREN STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:STEPHEN
Last Name:VRANISH
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 1:1287 BURNS WAY
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3109
Mailing Address - Country:US
Mailing Address - Phone:406-752-8120
Mailing Address - Fax:406-752-8134
Practice Address - Street 1:1287 BURNS WAY
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3109
Practice Address - Country:US
Practice Address - Phone:406-752-8120
Practice Address - Fax:406-752-8134
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3627207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1285672279OtherBCBS
MT1285672279Medicaid
MT1285672279OtherBCBS