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Organization
LIFE LINE MEDICAL GROUP INC
Active
Organization
LIFE LINE MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EULOGIO EMILIANO BENITEZ (PRESIDENT)
(786) 474-0541
Entity
Organization
Contact information
Practice address
12595 SW 137TH AVE STE 206, MIAMI, FL 33186-4221
(786) 474-0541
Mailing address
12595 SW 137TH AVE STE 206, MIAMI, FL 33186-4221
(786) 474-0541
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
NULL
Other
Enumeration date
10/20/2020
Last updated
10/20/2020
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