Provider Demographics
NPI:1861480006
Name:LORENZ, KEVIN M (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:LORENZ
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4112
Mailing Address - Country:US
Mailing Address - Phone:701-255-4673
Mailing Address - Fax:701-255-4934
Practice Address - Street 1:620 N 9TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4112
Practice Address - Country:US
Practice Address - Phone:701-255-4673
Practice Address - Fax:701-255-4934
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND7221207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13979OtherBLSH OF ND
SD7779480Medicaid
ND877221OtherND BLUE SHIELD VISION SER
ND18532Medicaid
ND877221OtherND BLUE SHIELD VISION SER
ND13979OtherBLSH OF ND