Organization
FL PERFORMANCE,LLC
Active
Other names
PhysIQ Lifestyle Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIM FAGAN M.D. (OWNER/MEDICAL DIRECTOR)
(205) 874-9940
Entity
Organization
Contact information
Practice address
3125 INDEPENDENCE DR, SUITE 300A1, HOMEWOOD, AL 35209-4159
(205) 802-5949
Mailing address
3125 INDEPENDENCE DR, SUITE 300A1, HOMEWOOD, AL 35209-4159
(205) 802-5949
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
14105
AL
Other
Enumeration date
11/13/2014
Last updated
11/13/2014
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