Provider Demographics
NPI:1013917525
Name:LOVY, ANDREW (D O)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:LOVY
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29400 LAKE WAY
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-8414
Mailing Address - Country:US
Mailing Address - Phone:660-665-1618
Mailing Address - Fax:
Practice Address - Street 1:303 WELLER ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-1942
Practice Address - Country:US
Practice Address - Phone:660-395-0180
Practice Address - Fax:660-395-0181
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030251322084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209026905Medicaid
MO000090907Medicare ID - Type Unspecified
MO209026905Medicaid