Provider Demographics
NPI:1245221076
Name:LUOMA, DAVID MICHAEL (MD, MMM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:LUOMA
Suffix:
Gender:M
Credentials:MD, MMM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 PRESQUE ISLE AVENUE
Mailing Address - Street 2:NORTHERN MICHIGAN UNIVERSITY VIELMETTI HEALTH CENTER
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855
Mailing Address - Country:US
Mailing Address - Phone:906-227-2355
Mailing Address - Fax:906-227-2332
Practice Address - Street 1:1401 PRESQUE ISLE AVENUE
Practice Address - Street 2:NORTHERN MICHIGAN UNIVERSITY VIELMETTI HEALTH CENTER
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-227-2355
Practice Address - Fax:906-227-2332
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-01
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301042739207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1585770Medicaid
MI080036033OtherRAILROAD MEDICARE
MI1585770Medicaid
MI080036033OtherRAILROAD MEDICARE