Provider Demographics
NPI:1982696340
Name:HIRATZKA, LOREN FORREST (MD)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:FORREST
Last Name:HIRATZKA
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 1:10506 MONTGOMERY ROAD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242
Mailing Address - Country:US
Mailing Address - Phone:513-865-5120
Mailing Address - Fax:513-865-5121
Practice Address - Street 1:10506 MONTGOMERY RD
Practice Address - Street 2:SUITE 302
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242
Practice Address - Country:US
Practice Address - Phone:513-865-5120
Practice Address - Fax:513-865-5121
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25039174400000X, 208600000X, 208G00000X
OH35054450H208600000X, 208G00000X
CAC34038208600000X, 208G00000X
IA18359208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0640202Medicaid
000000005631OtherANTHEM
1820061OtherUNITEDHEALTHCARE
310804060031OtherCARESOURCE
54450OtherCHOICE CARE/HUMANA
8330OtherKY BCBS
KY64862717Medicaid
IN200057970AMedicaid
8330OtherKY BCBS
310804060031OtherCARESOURCE
000000005631OtherANTHEM
330004325Medicare ID - Type UnspecifiedRAILROAD MEDICARE
KY330004282Medicare PIN
0672712Medicare PIN
330004325Medicare PIN
A16673Medicare UPIN
1820061OtherUNITEDHEALTHCARE