MEDICARE: SHARON LOFTUS MT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	1003046	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1003046	OTHER	WI	STATE LICENSE
2	27929900	OTHER	WI	NATIONAL CERTIFICATION BOARD #

General Provider Information

NPI Number	:	1649447764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON LOFTUS MT

Provider Business Mailing Address
First Line	:	N63W23524 SILVER SPRING DR # 4
Second Line	:
City	:	SUSSEX
State	:	WI
Zip	:	53089-3833
Country	:	US
Telephone Number	:	262-246-8410
Fax Number	:	262-246-8894

Provider Business Practice Location Address
First Line	:	N63W23524 SILVER SPRING DR # 4
Second Line	:
City	:	SUSSEX
State	:	WI
Zip	:	53089-3833
Country	:	US
Telephone Number	:	262-246-8410
Fax Number	:	262-246-8894

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	05/08/2008

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Directions to “ SHARON LOFTUS MT” Practice Location

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