Healthcare Provider Details

I. General information

NPI: 1538322086
Provider Name (Legal Business Name): MICHAEL ROBERT LOVY MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2008
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N INDIAN CANYON DR W-201
PALM SPRINGS CA
92262-4800
US

IV. Provider business mailing address

PO BOX 533
THOUSAND PALMS CA
92276-0533
US

V. Phone/Fax

Practice location:
  • Phone: 760-416-4511
  • Fax: 760-416-4512
Mailing address:
  • Phone: 760-416-4511
  • Fax: 760-416-4512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG87946
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL ROBERT LOVY
Title or Position: PRESIDENT
Credential: MD
Phone: 760-416-4511