Organization
GLENDALE WEIGHTLOSS LLC
Active
Other names
Medi-Weightloss
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD KALOUST (MANAGER MEMBER)
(813) 228-6334
Entity
Organization
Contact information
Practice address
5310 W THUNDERBIRD RD, STE 308, GLENDALE, AZ 85306-4706
(623) 825-7931
(623) 240-2673
Mailing address
509 S HYDE PARK AVE, TAMPA, FL 33606-2266
(813) 228-6334
(813) 228-6763
Taxonomy
Speciality
Code
Description
License number
State
207QB0002X
Obesity Medicine (Family Medicine) Physician
Primary
500010862
AZ
Other
Enumeration date
06/23/2015
Last updated
06/23/2015
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