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General NPI Number Information
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NPI Number | 1477883197
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Entity Type | Organization
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Legal Business Name | LIFESTYLE THERAPEUTICS LLC
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Dates
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Enumeration Date | 12/31/2009
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Last Update Date | 12/31/2009
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Provider Practice Location Address
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Address Line | 2300 GLADES RD SUITE 305 EAST
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City | BOCA RATON
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State | FL
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Zip | 33431-7386
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Country | US
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Telephone | 561-395-0845
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Fax | 561-218-1773
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Provider Business Mailing Address
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Address Line | 2300 GLADES RD SUITE 305 EAST
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City | BOCA RATON
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State | FL
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Zip | 33431-7386
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Country | US
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Telephone | 561-395-0845
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Fax | 561-218-1773
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Authorized Official
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Title or Position | OWNER
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Name | LAURA D BAUM
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Credential | MD
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Telephone | 561-395-0845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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