Individual
DR. LOYD J WOLLSTADT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
405 CHARLES ST, UNIVERSITY PRIMARY CARE CLINIC MT MORRIS, MOUNT MORRIS, IL 61054-1646
(815) 734-6061
(815) 734-9021
Mailing address
1601 PARKVIEW AVE, CREDENTIALING S200, ROCKFORD, IL 61107-1822
(815) 395-5861
(815) 395-5575
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036050197
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036050197
IL STATE LICENSE
IL
05
—
036050197
—
IL
Enumeration date
10/28/2005
Last updated
09/03/2010
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