Organization
ARIZONA LS LLC
Active
Other names
Medi-Weightloss
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN KALOUST (MANAGER MEMBER)
(813) 228-6334
Entity
Organization
Contact information
Practice address
966 HOUSTON NORTHCUTT BLVD, STE G, MT PLEASANT, SC 29464-3487
(843) 388-6334
(843) 388-4197
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
20034883
SC
Other
Enumeration date
06/23/2015
Last updated
06/23/2015
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