Provider Demographics
NPI:1336692243
Name:KJC MEDI WEIGHTLOSS LLC
Entity Type:Organization
Organization Name:KJC MEDI WEIGHTLOSS LLC
Other - Org Name:MEDIWEIGHTLOSS OF WAKEFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KILP
Authorized Official - Suffix:
Authorized Official - Credentials:ACOG
Authorized Official - Phone:781-245-6334
Mailing Address - Street 1:603 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1227
Mailing Address - Country:US
Mailing Address - Phone:781-245-6334
Mailing Address - Fax:
Practice Address - Street 1:603 SALEM ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1227
Practice Address - Country:US
Practice Address - Phone:781-245-6334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50673207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty