Healthcare Provider Details

I. General information

NPI: 1073595757
Provider Name (Legal Business Name): THOMAS A. LOSEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 WEST HIGH STREET MIDWEST COMMUNITY HEALTH ASSOCIATES
BRYAN OH
43506
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 419-636-4517
  • Fax: 419-636-6438
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35075250L
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: