Individual
GARY LOFGREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-7334
(216) 844-3781
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
211639
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221232
UNISON
OH
01
—
000000515994
ANTHEM
OH
01
—
0583328
BCMH
OH
05
—
0918761
—
OH
01
—
415004
WELLCARE MEDICAID
OH
01
—
7109263
AETNA
OH
01
—
748693
BUCKEYE MEDICAID
OH
01
—
P00457955
RAILROAD MEDICARE
OH
Enumeration date
08/11/2005
Last updated
11/21/2013
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