Provider Demographics
NPI:1477517241
Name:LOEHLE, LAWRENCE D (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:D
Last Name:LOEHLE
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-272-5100
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:STE 700
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3900
Practice Address - Country:US
Practice Address - Phone:502-629-5400
Practice Address - Fax:502-629-5492
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19843207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2529093001OtherCIGNA / NMA
KY64198435Medicaid
1055979OtherPASSPORT - NMA
IN100374290Medicaid
1183271OtherCHA / NMA
2433821000OtherPAD - NMA
009371OtherSIHO - NMA
KYP00268840OtherRRMCR - NMA
000000350642OtherANTHEM - NMA
KY50023127OtherPASSPORT- NORTON INPATIENT SPECIALISTS
2529093001OtherCIGNA / NMA
KY0361949Medicare PIN