Basic Information
| Provider Information | |||||||||
| NPI: | 1376658864 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOWE | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1234 E DUPONT RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468251545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2602668900 | ||||||||
| FaxNumber: | 2602668935 | ||||||||
| Practice Location | |||||||||
| Address1: | 11141 PARKVIEW PLAZA DR | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468451713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2602666890 | ||||||||
| FaxNumber: | 2602668935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 02/16/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 01074552A | IN | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 9338635 | 01 | OH | PARTNERS PHYSICIAN GROUP MEDICARE GROUP NUMBER | OTHER | 3010904 | 01 | OH | ACUTE CARE SURGERY SERVICE AT AKRON GENERAL MEDICAID # | OTHER | 9382831 | 01 | OH | ACUTE CARE SURGERY SERVICE AT AKRON GENERAL MEDICARE # | OTHER | H008171 | 01 | OH | ACUTE CARE SURGERY SERVICE INDIVIDUAL MEDICARE # | OTHER | 1841239274 | 01 | OH | PARTNERS PHYSICIAN GROUP TYPE 2 NPI NUMBER | OTHER | 1376779702 | 01 | OH | ACUTE CARE SURGERY SERVICE AT AKRON GENERAL TYPE 2 NPI # | OTHER | 2551671 | 01 | PARTNERS PHYSICIAN GROUP MEDICAID GROUP NUMBER | OTHER | 3156776 | 05 | OH | MEDICAID |