Provider Demographics
NPI:1376312991
Name:LIFESTYLERX FLORIDA, P.A.
Entity Type:Organization
Organization Name:LIFESTYLERX FLORIDA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-619-1329
Mailing Address - Street 1:20 UNIVERSITY RD FLOOR 5
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5815
Mailing Address - Country:US
Mailing Address - Phone:778-653-2427
Mailing Address - Fax:877-735-0289
Practice Address - Street 1:20 UNIVERSITY RD FLOOR 5
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5815
Practice Address - Country:US
Practice Address - Phone:778-653-2427
Practice Address - Fax:877-735-0289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty