Provider Demographics
NPI:1407960776
Name:LOREN, MICHAEL LEWIS (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEWIS
Last Name:LOREN
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 1:10129 HEMLOCK DR
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-3452
Mailing Address - Country:US
Mailing Address - Phone:913-649-5152
Mailing Address - Fax:
Practice Address - Street 1:4963 NE GOODVIEW CIR
Practice Address - Street 2:SUITE A
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-1998
Practice Address - Country:US
Practice Address - Phone:816-478-1500
Practice Address - Fax:816-478-3413
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2A06207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO08334038OtherBC/BS OF KANSAS CITY
MOC50394Medicare UPIN
0004431Medicare ID - Type Unspecified