MEDICARE: DR. KATHLEEN COLE LOVLIE MD

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
1	208000000X	Pediatrics Physician	22320	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39807	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1609868454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN COLE LOVLIE MD

Provider Business Mailing Address
First Line	:	232 OFFICE PARK DR
Second Line	:
City	:	GULF SHORES
State	:	AL
Zip	:	36542-3432
Country	:	US
Telephone Number	:	251-968-2323
Fax Number	:	251-968-2134

Provider Business Practice Location Address
First Line	:	232 OFFICE PARK DR
Second Line	:
City	:	GULF SHORES
State	:	AL
Zip	:	36542-3432
Country	:	US
Telephone Number	:	251-968-2323
Fax Number	:	251-968-2134

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	07/08/2007

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