Organization
INDIANA MEDICAL WEIGHT LOSS & WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LANNY JAY BRAFF (MEMBER)
(631) 445-5063
Entity
Organization
Contact information
Practice address
1605 CHESTER BLVD, RICHMOND, IN 47374-1610
(765) 373-8253
(765) 488-0656
Mailing address
4536 NW BOXWOOD DR, CORVALLIS, OR 97330-3385
(631) 445-5063
Taxonomy
Speciality
Code
Description
License number
State
207RB0002X
Obesity Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
02/05/2021
Last updated
12/02/2021
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