Healthcare Provider Details

I. General information

NPI: 1215928841
Provider Name (Legal Business Name): LILLIAN J. LOVE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 4TH AVE N LUGERT WEST BUILDING
NAPLES FL
34102-5729
US

IV. Provider business mailing address

4371 VERONICA S SHOEMAKER BLVD
FORT MYERS FL
33916-2216
US

V. Phone/Fax

Practice location:
  • Phone: 239-434-2622
  • Fax: 239-434-6876
Mailing address:
  • Phone: 239-274-8200
  • Fax: 239-278-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME32463
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: