=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043276660
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT MICHAEL LOVE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2006
-----------------------------------------------------
Last Update Date | 06/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1091 PORT MALABAR BLVD NE STE 3
-----------------------------------------------------
City | PALM BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32905-5100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-723-4616
-----------------------------------------------------
Fax | 321-722-2186
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1091 PORT MALABAR BLVD NE STE 3
-----------------------------------------------------
City | PALM BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32905-5100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-723-4616
-----------------------------------------------------
Fax | 321-722-2186
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | ME48227
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------