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NPI Code Detail

MEDICARE: MIKEAL ROBERT LOVE M.D.

MEDICARE: MIKEAL ROBERT LOVE 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
1207RH0002XHospice and Palliative Medicine (Internal Medicine) PhysicianE-13080AR
2207V00000XObstetrics & Gynecology PhysicianH7322TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1TXB118821OTHERTXMEDICARE PTAN

General Provider Information

NPI Number : 1891788428
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKEAL ROBERT LOVE M.D.
Provider Business Mailing Address
First Line : 174 E CYDNEE ST
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-3987
Country : US
Telephone Number : 512-773-9682
Fax Number :
Provider Business Practice Location Address
First Line : 1100 N COLLEGE AVE
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-1944
Country : US
Telephone Number : 479-443-4301
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2005
Last Update Date : 09/08/2025

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