Individual
PHILLIP GLENN LOUGHEED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-BC, RN
Contact information
Practice address
24255 W 13 MILE RD, BINGHAM FARMS, MI 48025-4320
(248) 723-9613
Mailing address
413 WALNUT AVE, ROYAL OAK, MI 48073-5310
(810) 938-8201
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F10201475
MI
Other
Enumeration date
01/27/2021
Last updated
01/27/2021
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