Provider Demographics
NPI:1215915624
Name:LOFTUS, MARNIE M (DO)
Entity type:Individual
Prefix:
First Name:MARNIE
Middle Name:M
Last Name:LOFTUS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 N ANKENY BLVD
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4006
Mailing Address - Country:US
Mailing Address - Phone:515-964-4600
Mailing Address - Fax:515-964-9838
Practice Address - Street 1:1105 N ANKENY BLVD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4006
Practice Address - Country:US
Practice Address - Phone:515-964-4600
Practice Address - Fax:515-964-9838
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3339207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA080182615OtherRR MEDICARE
IA3253054Medicaid
IA1215915624Medicaid
IA1253054Medicaid
IA4253054Medicaid
IA2253054Medicaid
IA4253054Medicaid
IAI6454Medicare PIN