Healthcare Provider Details

I. General information

NPI: 1790850626
Provider Name (Legal Business Name): STUART T. LOVE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 BELLEMEADE AVE SUITE 108
EVANSVILLE IN
47714-0102
US

IV. Provider business mailing address

3700 BELLEMEADE AVE SUITE 108
EVANSVILLE IN
47714-0106
US

V. Phone/Fax

Practice location:
  • Phone: 812-401-1285
  • Fax: 812-401-1290
Mailing address:
  • Phone: 812-401-1285
  • Fax: 812-401-1290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07000987A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: