=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578968681
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOVOI MHT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2014
-----------------------------------------------------
Last Update Date | 05/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1515 HERITAGE DRIVE SUITE 110
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75069-3379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-616-4932
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1515 HERITAGE DRIVE SUITE 110
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75069-3379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-616-4932
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / PRESIDENT
-----------------------------------------------------
Name | MICHAEL LOVOI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 361-387-5161
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | H4502
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------