Doctor Mike LLC
Organization Active NPI Family Medicine Physician · Fayetteville, TN
NPI 1245055227 · NPPES record last updated Nov 15, 2024
Key facts
- NPI
- 1245055227
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- DOCTOR MIKE LLC
- Practice address
- 305 College St W
Fayetteville, TN 37334-2911 - Phone
- (931) 227-4984
- Fax
- (931) 227-4985
- NPI assigned
- Nov 15, 2024
- Organization subpart
- No
Authorized official
- Name
- Michael Peter Loiacono, MD
- Title
- MD/Owner
- Phone
- (931) 227-6091
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250218001223 | TN | Part B Supplier - Clinic/Group Practice | 0244750503 |
Receives reassigned benefits from 1 practitioner Practice locations: Fayetteville, TN |
National Provider Directory
Locations
305 College St W
Fayetteville, TN 37334
Phone (931) 227-4984
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
305 College St W
Fayetteville, TN 37334-2911
Mailing address
305 College St W
Fayetteville, TN 37334-2911
Phone (931) 227-4984
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All providers in Fayetteville, TN · Family Medicine Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.