MEDICARE: MIKEL W LO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	25801	AZ
2	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	25801	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	124361	OTHER	AZ	HEALTHNET
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578557914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKEL W LO MD

Provider Business Mailing Address
First Line	:	5940 N. LA CHOLLA BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741
Country	:	US
Telephone Number	:	520-877-2725
Fax Number	:	520-547-0220

Provider Business Practice Location Address
First Line	:	5940 N. LA CHOLLA BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741
Country	:	US
Telephone Number	:	520-877-2725
Fax Number	:	520-547-0220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	06/28/2016

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Directions to “ MIKEL W LO MD” Practice Location

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