Provider Demographics
NPI:1932375524
Name:L & M MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:L & M MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHOLPON
Authorized Official - Middle Name:
Authorized Official - Last Name:SABYROVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-239-0578
Mailing Address - Street 1:2100 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-3765
Mailing Address - Country:US
Mailing Address - Phone:954-239-0578
Mailing Address - Fax:954-239-0582
Practice Address - Street 1:2100 E HALLANDALE BEACH BLVD
Practice Address - Street 2:STE 202
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3765
Practice Address - Country:US
Practice Address - Phone:954-239-0578
Practice Address - Fax:954-239-0582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
02466BOtherMEDICARE