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General NPI Number Information
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NPI Number | 1649729385
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Entity Type | Organization
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Legal Business Name | LIFESTYLE & INTEGRATIVE MEDICINE OF TRI-CITIES PLLC
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 925 STEVENS DR SUITE # 3D
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City | RICHLAND
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State | WA
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Zip | 99352-3523
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Country | US
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Telephone | 509-943-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 646 SUMMIT ST
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City | RICHLAND
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State | WA
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Zip | 99352-7326
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DEEPSHIKHA DATTA
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Credential | M.D.
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Telephone | 509-943-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | MD00037451
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License Number State | WA
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