Provider Demographics
NPI:1386866044
Name:LIFESTYLE SOLUTIONS MEDSPA PL
Entity Type:Organization
Organization Name:LIFESTYLE SOLUTIONS MEDSPA PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-368-2148
Mailing Address - Street 1:2139 NE 2ND ST STE B
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-8264
Mailing Address - Country:US
Mailing Address - Phone:352-368-2148
Mailing Address - Fax:352-368-5892
Practice Address - Street 1:2139 NE 2ND ST STE B
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-8264
Practice Address - Country:US
Practice Address - Phone:352-368-2148
Practice Address - Fax:352-368-5892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89480207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty