Provider Demographics
NPI:1376501163
Name:LOOMIS, THOMAS D (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:D
Last Name:LOOMIS
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 1:8881 M 119
Mailing Address - Street 2:
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740-9479
Mailing Address - Country:US
Mailing Address - Phone:231-347-5400
Mailing Address - Fax:231-348-2515
Practice Address - Street 1:8881 M-119
Practice Address - Street 2:
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740
Practice Address - Country:US
Practice Address - Phone:231-347-5400
Practice Address - Fax:231-348-2515
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI412087610Medicaid
MIP95194OtherBLUE CARE NETWORK
MI081B410330OtherBCBS GROUP BILL #
MI0802400892OtherBCBS PIN
MIP95194OtherBLUE CARE NETWORK
MI081B410330OtherBCBS GROUP BILL #