Provider Demographics
NPI:1902057805
Name:JOSEPH F. LOOBY, D.O., P.C.
Entity type:Organization
Organization Name:JOSEPH F. LOOBY, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:LOOBY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-942-2675
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-0071
Mailing Address - Country:US
Mailing Address - Phone:616-942-2675
Mailing Address - Fax:616-942-2596
Practice Address - Street 1:2540 WOODMEADOW DR SE
Practice Address - Street 2:SUITE 102
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8050
Practice Address - Country:US
Practice Address - Phone:616-942-2675
Practice Address - Fax:616-942-2596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4653892Medicaid
MI4653892Medicaid
MIOPO360Medicare PIN