Provider Demographics
NPI:1558989210
Name:LIFEMED GROUP LLC
Entity Type:Organization
Organization Name:LIFEMED GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:BRAUN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-674-9321
Mailing Address - Street 1:2555 COLLINS AVE STE C4
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4723
Mailing Address - Country:US
Mailing Address - Phone:305-674-9321
Mailing Address - Fax:
Practice Address - Street 1:2555 COLLINS AVE STE C4
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4723
Practice Address - Country:US
Practice Address - Phone:305-674-9321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty