Basic Information
| Provider Information | |||||||||
| NPI: | 1508867631 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOAR | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | GRAHAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2695 ROCKY MOUNTAIN AVE STE 150 | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805389071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706244123 | ||||||||
| FaxNumber: | 9706242416 | ||||||||
| Practice Location | |||||||||
| Address1: | 206 W COUNTY LINE RD STE 210 | ||||||||
| Address2: | |||||||||
| City: | HIGHLANDS RANCH | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801292320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037955980 | ||||||||
| FaxNumber: | 3037957881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 10/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25456 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01254564 | 05 | CO | MEDICAID | 080146383 | 01 | CO | RAILROAD MEDICARE | OTHER |