Organization
DOCTOR MIKE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL PETER LOIACONO MD (MD/OWNER)
(931) 227-6091
Entity
Organization
Contact information
Practice address
305 COLLEGE ST W, FAYETTEVILLE, TN 37334-2911
(931) 227-4984
(931) 227-4985
Mailing address
305 COLLEGE ST W, FAYETTEVILLE, TN 37334-2911
(931) 227-4984
(931) 227-4985
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
11/15/2024
Last updated
11/15/2024
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