Healthcare Provider Details

I. General information

NPI: 1376693770
Provider Name (Legal Business Name): JOHN LLOYD LOEWEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 WASHINGTON AVE
NIAGARA WI
54151-1213
US

IV. Provider business mailing address

615 WASHINGTON AVE
NIAGARA WI
54151-1213
US

V. Phone/Fax

Practice location:
  • Phone: 715-251-3104
  • Fax: 715-251-1693
Mailing address:
  • Phone: 715-251-3104
  • Fax: 715-251-1693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20876 020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: