Basic Information
Provider Information
NPI: 1851686281
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LOMELI
FirstName: LUIS
MiddleName: D
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7974 UW HEALTH CT
Address2:  
City: MIDDLETON
State: WI
PostalCode: 535625531
CountryCode: US
TelephoneNumber: 9999999999
FaxNumber:  
Practice Location
Address1: UW HOSPITAL AND CLINICS
Address2: 600 HIGHLAND AVE, H4/831
City: MADISON
State: WI
PostalCode: 53792
CountryCode: US
TelephoneNumber: 6082634034
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/14/2011
LastUpdateDate: 01/28/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/28/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0100X62320-20WIY Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

No ID Information.


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