# LIFE LINE MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174122337
- **Authorized official:** EULOGIO EMILIANO BENITEZ (PRESIDENT)
- **Authorized official phone:** (786) 474-0541

## Contact information

- **Practice address:** 12595 SW 137TH AVE STE 206, MIAMI, FL 33186-4221
- **Practice address phone:** (786) 474-0541
- **Mailing address:** 12595 SW 137TH AVE STE 206, MIAMI, FL 33186-4221
- **Mailing address phone:** (786) 474-0541

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 10/20/2020
- **Last updated:** 10/20/2020