Provider Demographics
NPI:1366838823
Name:NTANDEM FITNESS AND NUTRITION, LLC
Entity Type:Organization
Organization Name:NTANDEM FITNESS AND NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:HOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-693-2037
Mailing Address - Street 1:1064 EVERETT AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1272
Mailing Address - Country:US
Mailing Address - Phone:502-693-2037
Mailing Address - Fax:502-795-3507
Practice Address - Street 1:239 HOOHANA ST
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2452
Practice Address - Country:US
Practice Address - Phone:502-693-2037
Practice Address - Fax:502-795-3507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-11
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI17081207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
421264647OtherFEIN
KYF26372Medicare UPIN
IA48197Medicare UPIN