Provider Demographics
NPI:1891816427
Name:KIELHORN, LORENZ P (MD)
Entity Type:Individual
Prefix:MR
First Name:LORENZ
Middle Name:P
Last Name:KIELHORN
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 1:401 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-2748
Mailing Address - Country:US
Mailing Address - Phone:269-344-4458
Mailing Address - Fax:269-344-4459
Practice Address - Street 1:401 HOWARD ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-2748
Practice Address - Country:US
Practice Address - Phone:269-344-4458
Practice Address - Fax:269-344-4459
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042187207QA0401X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MILK042187OtherBLUE CROSS BLUE SHIELD
MIN77250003Medicare PIN
MIMI6169002Medicare PIN
MIMI8533003Medicare PIN
MILK042187OtherBLUE CROSS BLUE SHIELD