Provider Demographics
NPI:1659551133
Name:JAMES R LOVELL M.D., P.C.
Entity Type:Organization
Organization Name:JAMES R LOVELL M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOVELL M.D., P.C.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-225-3955
Mailing Address - Street 1:1414 W FAIR AVE
Mailing Address - Street 2:SUITE 247
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2675
Mailing Address - Country:US
Mailing Address - Phone:906-225-3955
Mailing Address - Fax:906-225-4480
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:SUITE 247
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2675
Practice Address - Country:US
Practice Address - Phone:906-225-3955
Practice Address - Fax:906-225-4480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJL027611174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1059666Medicaid
MI0528298OtherBLUE CROSS BLUE SHIELD
MI161656937OtherPALMETTO RR MCR
MI1059666Medicaid
MI161656937OtherPALMETTO RR MCR