Provider Demographics
NPI:1992276190
Name:LIFETIME FAMILY WELLNESS AND WEIGHT LOSS PLLC
Entity type:Organization
Organization Name:LIFETIME FAMILY WELLNESS AND WEIGHT LOSS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SADOUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-201-8737
Mailing Address - Street 1:1531 HIGHWAY 90 A # 200
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-1226
Mailing Address - Country:US
Mailing Address - Phone:281-201-8737
Mailing Address - Fax:281-201-8739
Practice Address - Street 1:1531 HIGHWAY 90 A # 200
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-1226
Practice Address - Country:US
Practice Address - Phone:281-201-8737
Practice Address - Fax:281-201-8739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty