Provider Demographics
NPI:1790850626
Name:LOVE, STUART T (DPM)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:T
Last Name:LOVE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 BELLEMEADE AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0106
Mailing Address - Country:US
Mailing Address - Phone:812-401-1285
Mailing Address - Fax:812-401-1290
Practice Address - Street 1:3700 BELLEMEADE AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0102
Practice Address - Country:US
Practice Address - Phone:812-401-1285
Practice Address - Fax:812-401-1290
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000987A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN220810Medicare ID - Type Unspecified
INV02182Medicare UPIN