Basic Information
| Provider Information | |||||||||
| NPI: | 1801862446 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOAR HEBLE AND KNIGHT P LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LOAR HEBLE AND KNIGHT FAMILY PHYSICIANS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7780 S BROADWAY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801222648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037955980 | ||||||||
| FaxNumber: | 3037957881 | ||||||||
| Practice Location | |||||||||
| Address1: | 7780 S BROADWAY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801222648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037955980 | ||||||||
| FaxNumber: | 3037957881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 06/01/2017 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LOAR | ||||||||
| AuthorizedOfficialFirstName: | MICAHEL | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3037955980 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 85485276 | 05 | CO | MEDICAID | 080146383 | 01 | CO | MEDICARE RAILROAD | OTHER |