| Doctor Mike Llc | |
|
305 College St W Fayetteville TN 37334-2911 | |
| (931) 227-4984 | |
| (931) 227-4985 |
| Full Name | Doctor Mike Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 305 College St W, Fayetteville, Tennessee |
| Authorized Official Name and Position | Michael Peter Loiacono (MD/OWNER) |
| Authorized Official Contact | 9312276091 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Doctor Mike Llc 305 College St W Fayetteville TN 37334-2911 Ph: (931) 227-4984 | Doctor Mike Llc 305 College St W Fayetteville TN 37334-2911 Ph: (931) 227-4984 |
| NPI Number | 1245055227 |
|---|---|
| Provider Enumeration Date | 11/15/2024 |
| Last Update Date | 11/15/2024 |
| Medicare PECOS PAC ID | 0244750503 |
|---|---|
| Medicare Enrollment ID | O20250218001223 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245055227 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Michael Loiacono |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568566156 PECOS PAC ID: 8527118264 Enrollment ID: I20200905000017 |
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