Healthcare Provider Details

I. General information

NPI: 1447297270
Provider Name (Legal Business Name): RALPH K LOSEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
GALENA IL
61036-8118
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
GALENA IL
61036-8118
US

V. Phone/Fax

Practice location:
  • Phone: 815-777-1340
  • Fax:
Mailing address:
  • Phone: 815-777-1340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number36068994
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: