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Organization
LIGHT MATTER SOLUTIONS LLC
Active
Organization
LIGHT MATTER SOLUTIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB KALLIATH DO (SOLE OWNER)
(256) 810-2308
Entity
Organization
Contact information
Practice address
333 E 2ND ST, RICHLAND CENTER, WI 53581-1914
(702) 453-3799
(702) 453-5741
Mailing address
2660 CRIMSON CANYON DR STE 130, LAS VEGAS, NV 89128-0846
(702) 453-3799
(702) 453-5741
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
02/05/2019
Last updated
02/05/2019
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