Provider Demographics
NPI:1356305270
Name:LOHEIDE, PAUL J (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:LOHEIDE
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 1:2425 LIME KILN LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3462
Mailing Address - Country:US
Mailing Address - Phone:502-899-7163
Mailing Address - Fax:502-897-9963
Practice Address - Street 1:2425 LIME KILN LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3462
Practice Address - Country:US
Practice Address - Phone:502-899-7163
Practice Address - Fax:502-897-9963
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34951207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64031693Medicaid
KY1361905Medicare ID - Type Unspecified
KY64031693Medicaid
KY0727103Medicare PIN