Individual
ANDREW S LOVELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1302 S ROGERS ST, BLOOMINGTON, IN 47403-4752
(812) 333-2663
Mailing address
PO BOX 1329, BLOOMINGTON, IN 47402-1329
(812) 353-9816
(812) 353-5228
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001090A
IN
363AS0400X
Surgical Physician Assistant
10001090A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000698304
ANTHEM
IN
Enumeration date
06/09/2009
Last updated
12/18/2020
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