Provider Demographics
NPI:1346247236
Name:LOFGREN, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:LOFGREN
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 1:18601 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:WI
Mailing Address - Zip Code:54773-8605
Mailing Address - Country:US
Mailing Address - Phone:715-538-4361
Mailing Address - Fax:
Practice Address - Street 1:1836 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-5429
Practice Address - Country:US
Practice Address - Phone:608-782-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30684207Q00000X
WI24201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
105859OtherUCARE MN
380G81OOtherBCBS MN
905632OtherAMERICAS PPO MN
0122268OtherMEDICA MN
MN242383900Medicaid
41084933956001C228OtherCHAMPUS
HP19586OtherHEALTH PARTNERS MN
NA2951015704OtherPREFERRED ONE MN
NA2951015704OtherPREFERRED ONE MN
41084933956001C228OtherCHAMPUS