Provider Demographics
NPI:1225525843
Name:LIVE WELL MEDICAL CARE PLLC
Entity Type:Organization
Organization Name:LIVE WELL MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MADHAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHINENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-906-0204
Mailing Address - Street 1:12945 LAKE PARC BEND DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-6192
Mailing Address - Country:US
Mailing Address - Phone:281-819-7869
Mailing Address - Fax:832-730-4494
Practice Address - Street 1:150 PINE FOREST DR STE 602
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-5304
Practice Address - Country:US
Practice Address - Phone:281-819-7869
Practice Address - Fax:832-730-4494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
P3120207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty