Provider Demographics
NPI:1710957022
Name:LOEB, LOUIS B II (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:B
Last Name:LOEB
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ELBIE
Other - Middle Name:L
Other - Last Name:LOEB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4440 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3315
Mailing Address - Country:US
Mailing Address - Phone:816-561-9200
Mailing Address - Fax:816-561-5766
Practice Address - Street 1:4440 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3315
Practice Address - Country:US
Practice Address - Phone:816-561-9200
Practice Address - Fax:816-561-5766
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104709207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOEL206967606Medicaid
B68377Medicare UPIN
MOD235648Medicare ID - Type Unspecified