Provider Demographics
NPI:1245055227
Name:DOCTOR MIKE LLC
Entity type:Organization
Organization Name:DOCTOR MIKE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:LOIACONO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-227-6091
Mailing Address - Street 1:305 COLLEGE ST W
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-2911
Mailing Address - Country:US
Mailing Address - Phone:931-227-4984
Mailing Address - Fax:931-227-4985
Practice Address - Street 1:305 COLLEGE ST W
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2911
Practice Address - Country:US
Practice Address - Phone:931-227-4984
Practice Address - Fax:931-227-4985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty