Provider Demographics
NPI:1194232462
Name:LIFELINE SCIENCES LLC
Entity type:Organization
Organization Name:LIFELINE SCIENCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP PRACTICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-898-5244
Mailing Address - Street 1:38955 HILLS TECH DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3431
Mailing Address - Country:US
Mailing Address - Phone:248-536-0786
Mailing Address - Fax:
Practice Address - Street 1:32000 NORTHWESTERN HWY STE 240
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1569
Practice Address - Country:US
Practice Address - Phone:248-536-0786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty