Individual
MIKEL W LO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5940 N. LA CHOLLA BLVD, TUCSON, AZ 85741
(520) 877-2725
(520) 547-0220
Mailing address
5940 N. LA CHOLLA BLVD, TUCSON, AZ 85741
(520) 877-2725
(520) 547-0220
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
25801
AZ
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
Primary
25801
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
124361
HEALTHNET
AZ
05
—
374223001
—
AZ
01
—
AZ0870940
BCBS
AZ
Enumeration date
08/31/2005
Last updated
06/28/2016
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