Provider Demographics
NPI:1053851303
Name:MAI, LOAN (DO)
Entity type:Individual
Prefix:
First Name:LOAN
Middle Name:
Last Name:MAI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7541 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6502
Mailing Address - Country:US
Mailing Address - Phone:727-819-9107
Mailing Address - Fax:727-819-9138
Practice Address - Street 1:7541 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6502
Practice Address - Country:US
Practice Address - Phone:727-819-9107
Practice Address - Fax:727-819-9138
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS19854208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery