Provider Demographics
NPI:1063496248
Name:LIFE FAMILY PRACTICE CENTER
Entity Type:Organization
Organization Name:LIFE FAMILY PRACTICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARSENIJEVITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-750-4333
Mailing Address - Street 1:1501 N US HIGHWAY 441
Mailing Address - Street 2:1702
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8999
Mailing Address - Country:US
Mailing Address - Phone:352-750-4333
Mailing Address - Fax:352-750-2034
Practice Address - Street 1:1501 N US HIGHWAY 441
Practice Address - Street 2:1702
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-8999
Practice Address - Country:US
Practice Address - Phone:352-750-4333
Practice Address - Fax:352-750-2034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40031Medicare ID - Type Unspecified