# METAIRIE TOTAL WELLNESS CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MODERN MALE T-CLINIC, P.A.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1356830251
- **Legal business name:** MODERN MALE T-CLINIC, P.A.
- **Authorized official:** SALVATORE CAMPO DO (DO / PHYSICIAN)
- **Authorized official phone:** (214) 714-5343

## Contact information

- **Practice address:** 1813 VETERANS MEMORIAL BLVD STE B, METAIRIE, LA 70005-2637
- **Practice address phone:** (800) 246-5698
- **Mailing address:** 5000 ELDORADO PKWY STE 150-153, FRISCO, TX 75033-8695

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207QA0505X | Adult Medicine Physician | — | NULL | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/07/2018
- **Last updated:** 05/07/2018