Provider Demographics
NPI:1275178642
Name:REAL LIFE MEDICAL LLC
Entity Type:Organization
Organization Name:REAL LIFE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DAUPHINAIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-470-6630
Mailing Address - Street 1:1245 FARMINGTON AVE # 226
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2667
Mailing Address - Country:US
Mailing Address - Phone:860-470-6630
Mailing Address - Fax:862-298-0763
Practice Address - Street 1:1245 FARMINGTON AVE # 226
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2667
Practice Address - Country:US
Practice Address - Phone:860-470-6630
Practice Address - Fax:862-298-0763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-09
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty