Healthcare Provider Details

I. General information

NPI: 1548254394
Provider Name (Legal Business Name): JEFFREY L LOUGHEAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N WINFIELD RD
WINFIELD IL
60190-1222
US

IV. Provider business mailing address

225 E CHICAGO AVE # 152
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-2350
  • Fax: 630-933-6519
Mailing address:
  • Phone: 630-933-6602
  • Fax: 630-933-6519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number01091889A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036-097718
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: