1376658864 NPI number — KEVIN MICHAEL LOWE MD

Table of content: (NPI 1992511745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376658864 NPI number — KEVIN MICHAEL LOWE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOWE
Provider First Name:
KEVIN
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376658864
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 N SHADELAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46219-4959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7230 ENGLE RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46804-2234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-234-5400
Provider Business Practice Location Address Fax Number:
260-234-5435
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  01074552A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2551671 . This is a "PARTNERS PHYSICIAN GROUP MEDICAID GROUP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3010904 . This is a "ACUTE CARE SURGERY SERVICE AT AKRON GENERAL MEDICAID #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 300069685 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3156776 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9338635 . This is a "PARTNERS PHYSICIAN GROUP MEDICARE GROUP NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9382831 . This is a "ACUTE CARE SURGERY SERVICE AT AKRON GENERAL MEDICARE #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: H008171 . This is a "ACUTE CARE SURGERY SERVICE INDIVIDUAL MEDICARE #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: IN4866029 . This is a "MEDICARE PTAN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1376779702 . This is a "ACUTE CARE SURGERY SERVICE AT AKRON GENERAL TYPE 2 NPI #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1841239274 . This is a "PARTNERS PHYSICIAN GROUP TYPE 2 NPI NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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