Provider Demographics
NPI:1578672416
Name:LOESCH, RICHARD JOHN (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOHN
Last Name:LOESCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 1/2 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-1516
Mailing Address - Country:US
Mailing Address - Phone:812-386-6750
Mailing Address - Fax:812-385-3667
Practice Address - Street 1:418 1/2 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-1516
Practice Address - Country:US
Practice Address - Phone:812-386-6750
Practice Address - Fax:812-385-3667
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000440213E00000X
IL016.004190213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000054197OtherANTHEM
IL6020181OtherBLUE CROSS BLUE SHIELD
IL073517OtherHEALTH ALLIANCE
1007961OtherCIGNA
480006713Medicare PIN
IL073517OtherHEALTH ALLIANCE
IL6020181OtherBLUE CROSS BLUE SHIELD
T34654Medicare UPIN