Provider Demographics
NPI:1841570512
Name:NEW LIFE MEDICAL, LLC
Entity type:Organization
Organization Name:NEW LIFE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:R
Authorized Official - Last Name:KORN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-354-9700
Mailing Address - Street 1:2915 E BASELINE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2427
Mailing Address - Country:US
Mailing Address - Phone:480-354-6700
Mailing Address - Fax:480-354-6708
Practice Address - Street 1:2915 E BASELINE RD STE 105
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2427
Practice Address - Country:US
Practice Address - Phone:480-354-6700
Practice Address - Fax:480-354-6708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ109213208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty