MEDICARE: DR. RYAN WADE LOFTIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	68354	MN
2	207V00000X	Obstetrics & Gynecology Physician	M6264	TX
3	207VM0101X	Maternal & Fetal Medicine Physician	M6264	TX
4	207VM0101X	Maternal & Fetal Medicine Physician	68354	MN

General Provider Information

NPI Number	:	1447446265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN WADE LOFTIN M.D.

Provider Business Mailing Address
First Line	:	2925 CHICAGO AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1321
Country	:	US
Telephone Number	:	612-262-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	902 E 26TH ST STE 1700
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4514
Country	:	US
Telephone Number	:	612-863-4502
Fax Number	:	612-863-5697

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2007
Last Update Date	:	01/06/2021

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