Provider Demographics
NPI:1407841307
Name:LORIA, LOYDA O (MD)
Entity Type:Individual
Prefix:
First Name:LOYDA
Middle Name:O
Last Name:LORIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINNECONNE
Mailing Address - State:WI
Mailing Address - Zip Code:54986-9782
Mailing Address - Country:US
Mailing Address - Phone:920-582-1100
Mailing Address - Fax:
Practice Address - Street 1:916 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WINNECONNE
Practice Address - State:WI
Practice Address - Zip Code:54986-9782
Practice Address - Country:US
Practice Address - Phone:920-582-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30327207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31508800Medicaid
WI31508800Medicaid