Provider Demographics
NPI:1174630628
Name:LOOMANS, HENRY J (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:J
Last Name:LOOMANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:855 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OCONTO FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54154-1241
Mailing Address - Country:US
Mailing Address - Phone:920-846-3444
Mailing Address - Fax:920-846-2073
Practice Address - Street 1:835 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-1282
Practice Address - Country:US
Practice Address - Phone:920-846-8187
Practice Address - Fax:920-846-2073
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35770207R00000X
WI35770-20207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1326349135OtherCMH SB NPI
WI1467583096OtherCLINIC NPI
WI1174630628OtherBCBS
WI1851477913OtherCMH NPI
WI11014110Medicaid
WI207R00000XMedicaid
WI390806395041OtherCHAMPUS
WI207R00000XMedicaid
WI1174630628OtherBCBS
WI528546Medicare Oscar/Certification
WI520107Medicare Oscar/Certification
WI001038225Medicare PIN