# GLENDALE WEIGHTLOSS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medi-Weightloss
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376925602
- **Authorized official:** EDWARD KALOUST (MANAGER MEMBER)
- **Authorized official phone:** (813) 228-6334

## Contact information

- **Practice address:** 5310 W THUNDERBIRD RD, STE 308, GLENDALE, AZ 85306-4706
- **Practice address phone:** (623) 825-7931
- **Practice address fax:** (623) 240-2673
- **Mailing address:** 509 S HYDE PARK AVE, TAMPA, FL 33606-2266
- **Mailing address phone:** (813) 228-6334
- **Mailing address fax:** (813) 228-6763

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QB0002X | Obesity Medicine (Family Medicine) Physician | 500010862 | AZ | Yes |

## Other

- **Enumeration date:** 06/23/2015
- **Last updated:** 06/23/2015