Healthcare Provider Details

I. General information

NPI: 1104184076
Provider Name (Legal Business Name): TOU SHOUA JOHN LOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 COUNTY ROAD XX
KRONENWETTER WI
54455-7933
US

IV. Provider business mailing address

1881 COUNTY ROAD XX
KRONENWETTER WI
54455-7933
US

V. Phone/Fax

Practice location:
  • Phone: 715-355-4040
  • Fax:
Mailing address:
  • Phone: 715-355-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number62537
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: