Provider Demographics
NPI:1750305603
Name:LOFGREEN, JOHN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:LOFGREEN
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 1:1257 W WARNER RD
Mailing Address - Street 2:SUITE A-4
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2713
Mailing Address - Country:US
Mailing Address - Phone:480-777-9333
Mailing Address - Fax:480-838-9666
Practice Address - Street 1:1257 W WARNER RD
Practice Address - Street 2:SUITE A-4
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2713
Practice Address - Country:US
Practice Address - Phone:480-777-9333
Practice Address - Fax:480-838-9666
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13455207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ100813Medicare ID - Type Unspecified
AZC99889Medicare UPIN