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NPI Code Detail

MEDICARE: LOVELY PHILIPOSE M.D.

MEDICARE: LOVELY PHILIPOSE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianS0536TX
2207Q00000XFamily Medicine Physician35.094372OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386884286
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOVELY PHILIPOSE M.D.
Provider Business Mailing Address
First Line : PO BOX 746079
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6079
Country : US
Telephone Number : 773-352-1515
Fax Number : 312-929-0373
Provider Business Practice Location Address
First Line : 1950 EPHRIHAM AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76164-6670
Country : US
Telephone Number : 817-813-7075
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2009
Last Update Date : 09/16/2025

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Directions to “ LOVELY PHILIPOSE M.D.” Practice Location

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