Individual
MABRIA LOQMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2621 S GREEN BAY RD, RACINE, WI 53406-4948
(262) 504-6150
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036-097672
IL
207Q00000X
Family Medicine Physician
Primary
38253
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036097672
STATE LICENSE
IL
05
—
32275700
—
WI
Enumeration date
11/29/2006
Last updated
12/04/2023
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