Healthcare Provider Details

I. General information

NPI: 1902057805
Provider Name (Legal Business Name): JOSEPH F. LOOBY, D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 WOODMEADOW DR SE SUITE 102
GRAND RAPIDS MI
49546-8050
US

IV. Provider business mailing address

PO BOX 71
CALEDONIA MI
49316-0071
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-2675
  • Fax: 616-942-2596
Mailing address:
  • Phone: 616-942-2675
  • Fax: 616-942-2596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH FRANCIS LOOBY
Title or Position: OWNER
Credential: D.O.
Phone: 616-942-2675