MEDICARE: ROBERT EDWIN LOVE II 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	390200000X	Student in an Organized Health Care Education/Training Program
2	2085R0204X	Vascular & Interventional Radiology Physician	101131	WI
3	2085R0204X	Vascular & Interventional Radiology Physician	67619	MT

General Provider Information

NPI Number	:	1952676157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT EDWIN LOVE II MD

Provider Business Mailing Address
First Line	:	320 SUNNYVIEW LN
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-3129
Country	:	US
Telephone Number	:	406-751-9729
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 SUNNYVIEW LN
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901
Country	:	US
Telephone Number	:	406-751-9729
Fax Number	:

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

Provider Enumeration Date	:	03/20/2012
Last Update Date	:	05/21/2026

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