Provider Demographics
NPI:1376693770
Name:LOEWEN, JOHN LLOYD (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LLOYD
Last Name:LOEWEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA
Mailing Address - State:WI
Mailing Address - Zip Code:54151-1213
Mailing Address - Country:US
Mailing Address - Phone:715-251-3104
Mailing Address - Fax:715-251-1693
Practice Address - Street 1:615 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA
Practice Address - State:WI
Practice Address - Zip Code:54151-1213
Practice Address - Country:US
Practice Address - Phone:715-251-3104
Practice Address - Fax:715-251-1693
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20876 020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4673320Medicaid
WI32240900Medicaid
MI4673320Medicaid
WI40032Medicare ID - Type Unspecified
WI32240900Medicaid