Basic Information
| Provider Information | |||||||||
| NPI: | 1467418681 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOVERINK | ||||||||
| FirstName: | KAE | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5723 | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977085723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024533799 | ||||||||
| FaxNumber: | 7024535741 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 SUNRISE DR | ||||||||
| Address2: | |||||||||
| City: | SAINT PETER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560825376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5079347312 | ||||||||
| FaxNumber: | 5079348516 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35537 | CO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD159669 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01355379 | 05 | CO | MEDICAID |