MEDICARE: WILLIAM C LOOP MD PHD

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	4301042646	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811942303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM C LOOP MD PHD

Provider Business Mailing Address
First Line	:	3061 CHRISTY WAY
Second Line	:	C/O PRO MED BILLING
City	:	SAGINAW
State	:	MI
Zip	:	48603-2267
Country	:	US
Telephone Number	:	989-791-2455
Fax Number	:

Provider Business Practice Location Address
First Line	:	1691 E US 23
Second Line	:	STE 5
City	:	EAST TAWAS
State	:	MI
Zip	:	48730-9337
Country	:	US
Telephone Number	:	989-362-8628
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WILLIAM C LOOP
Credential	:	MD
Telephone Number	:	989-362-8628

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	09/28/2007

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