Life Line Medical Group Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

LIFE LINE MEDICAL GROUP INC

Practice address

12595 SW 137TH Ave Ste 206
Miami, FL 33186-4221

Phone

(786) 474-0541

NPI assigned

Oct 20, 2020

Last updated

Oct 20, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Eulogio Emiliano Benitez

Title

President

Phone

(786) 474-0541

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603152000000",
    "number": "1174122337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12595 SW 137TH AVE STE 206",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331864221",
            "telephone_number": "786-474-0541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12595 SW 137TH AVE STE 206",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331864221",
            "telephone_number": "786-474-0541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE LINE MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-20",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A",
        "authorized_official_last_name": "BENITEZ",
        "authorized_official_first_name": "EULOGIO",
        "authorized_official_middle_name": "EMILIANO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "786-474-0541"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Miami, FL
• Providers in Miami, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.