Provider Demographics
NPI:1932169174
Name:QUENEMOEN, LOWELL (MD)
Entity Type:Individual
Prefix:
First Name:LOWELL
Middle Name:
Last Name:QUENEMOEN
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 1:2900 12TH AVE N
Mailing Address - Street 2:STE 402E
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7591
Mailing Address - Country:US
Mailing Address - Phone:406-238-6670
Mailing Address - Fax:406-238-6690
Practice Address - Street 1:2900 12TH AVE N
Practice Address - Street 2:STE 402E
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7591
Practice Address - Country:US
Practice Address - Phone:406-238-6670
Practice Address - Fax:406-238-6690
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT83342084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT16151OtherBLUE CROSS BL;UE SHIELD
MT0036822Medicaid
A74807Medicare UPIN