Provider Demographics
NPI:1679552988
Name:LOOZE, THOMAS E (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:LOOZE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1120 PINE ST
Mailing Address - Street 2:PO BOX 156
Mailing Address - City:STANLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54768-0156
Mailing Address - Country:US
Mailing Address - Phone:715-644-5530
Mailing Address - Fax:715-644-6223
Practice Address - Street 1:704 S CLARK ST
Practice Address - Street 2:
Practice Address - City:THORP
Practice Address - State:WI
Practice Address - Zip Code:54771-7624
Practice Address - Country:US
Practice Address - Phone:715-669-7279
Practice Address - Fax:715-669-5674
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI26204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30736700Medicaid
AL2926066OtherDEA
WI30736700Medicaid