Provider Demographics
NPI:1932123478
Name:LOFTIN, GENE B III (MD)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:B
Last Name:LOFTIN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EUGENE
Other - Middle Name:B
Other - Last Name:LOFTIN
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:300 N. MARTINGALE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SCHAUMBURGQ
Mailing Address - State:IL
Mailing Address - Zip Code:60173-2098
Mailing Address - Country:US
Mailing Address - Phone:847-385-0660
Mailing Address - Fax:866-441-4306
Practice Address - Street 1:300 N MARTINGALE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-2407
Practice Address - Country:US
Practice Address - Phone:847-385-0660
Practice Address - Fax:866-441-4306
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051446207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036051446Medicaid
IL4500683OtherBLUE CROSS BLUE SHIELD IL
IL4500683OtherBLUE CROSS BLUE SHIELD IL
IL036051446Medicaid