Provider Demographics
NPI:1043276660
Name:LOVE, ROBERT MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:LOVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 PORT MALABAR BLVD NE
Mailing Address - Street 2:STE 3
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-5100
Mailing Address - Country:US
Mailing Address - Phone:321-723-4616
Mailing Address - Fax:321-722-2186
Practice Address - Street 1:1091 PORT MALABAR BLVD NE
Practice Address - Street 2:STE 3
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5100
Practice Address - Country:US
Practice Address - Phone:321-723-4616
Practice Address - Fax:321-722-2186
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME48227207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064786100Medicaid
FL064786100Medicaid
D27054Medicare UPIN