Provider Demographics
NPI:1568689875
Name:CLOVERLEAF FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:CLOVERLEAF FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING REPRESENTATIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:TURLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-269-4376
Mailing Address - Street 1:1064 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-4898
Mailing Address - Country:US
Mailing Address - Phone:203-634-3636
Mailing Address - Fax:203-634-1972
Practice Address - Street 1:1064 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-4898
Practice Address - Country:US
Practice Address - Phone:203-634-3636
Practice Address - Fax:203-634-1972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027029207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB77200Medicare UPIN
CTC01842Medicare ID - Type UnspecifiedGROUP PRACTICE NUMBER
CTE29194Medicare UPIN