Provider Demographics
NPI:1326515362
Name:LICE TROOPERS
Entity Type:Organization
Organization Name:LICE TROOPERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-276-0016
Mailing Address - Street 1:5640 COLLINS AVE APT 3A
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2436
Mailing Address - Country:US
Mailing Address - Phone:347-276-0016
Mailing Address - Fax:
Practice Address - Street 1:13027 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1708
Practice Address - Country:US
Practice Address - Phone:347-276-0016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty