Provider Demographics
NPI:1679749980
Name:LOWENSTEIN, KEITH G (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:G
Last Name:LOWENSTEIN
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 1:15160 NW LAID LAW RD
Mailing Address - Street 2:#240
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229
Mailing Address - Country:US
Mailing Address - Phone:503-384-0044
Mailing Address - Fax:503-384-0077
Practice Address - Street 1:15160 NW LAIDLAW RD STE 240
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-0014
Practice Address - Country:US
Practice Address - Phone:503-601-7004
Practice Address - Fax:503-601-6876
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17648208D00000X
OR0176482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
F77464Medicare UPIN