Provider Demographics
NPI:1720034325
Name:LOUVAR, EDMUND (MD)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:
Last Name:LOUVAR
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 1:1357 MARINA POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-3904
Mailing Address - Country:US
Mailing Address - Phone:810-733-6780
Mailing Address - Fax:810-733-8871
Practice Address - Street 1:G3239 BEECHER RD
Practice Address - Street 2:SUITE F
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3616
Practice Address - Country:US
Practice Address - Phone:810-733-6780
Practice Address - Fax:810-733-8871
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010619112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4192516Medicaid
MI4192599Medicaid
MI4345099Medicaid
MI4345099Medicaid