Provider Demographics
NPI:1093909491
Name:MIKEAL LOVE, M.D, PA
Entity Type:Organization
Organization Name:MIKEAL LOVE, M.D, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKEAL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-476-9699
Mailing Address - Street 1:900 E 30TH ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3326
Mailing Address - Country:US
Mailing Address - Phone:512-476-9699
Mailing Address - Fax:512-367-5799
Practice Address - Street 1:900 E 30TH ST
Practice Address - Street 2:SUITE 211
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3326
Practice Address - Country:US
Practice Address - Phone:512-476-9699
Practice Address - Fax:512-367-5799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7322207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00000033QNOtherBCBS
TX292934101Medicaid
TXTXB118820OtherMEDICARE PTAN
TX8AJ644OtherBCBS INDIV
TXTXB118820OtherMEDICARE PTAN