| NPI | 1255922217 |
|---|---|
| Former Legal Business Name | LIFESTYLE MEDICINE ,LLC |
| Entity Type | Organization |
| Authorized Contact | NICOLE ROBERSON Consultant 337-519-6304 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 261Q00000X |
| Enumeration Date | 2021-02-01 |
| Last Update Date | 2021-02-22 |