Healthcare Provider Details

I. General information

NPI: 1437110319
Provider Name (Legal Business Name): MICHAEL SEABORN LOVE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SAINT CHARLES ST
JASPER IN
47546-9145
US

IV. Provider business mailing address

1900 SAINT CHARLES ST
JASPER IN
47546-9145
US

V. Phone/Fax

Practice location:
  • Phone: 812-634-1211
  • Fax: 812-634-1582
Mailing address:
  • Phone: 812-634-1211
  • Fax: 812-634-1582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01048505A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: