| Lifesmart Medical Center Pllc | |
|
2176 Fort St Lincoln Park MI 48146-2405 | |
| (313) 768-5096 | |
| (877) 409-3290 |
| Full Name | Lifesmart Medical Center Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2176 Fort St, Lincoln Park, Michigan |
| Authorized Official Name and Position | Amitha Parvataneni (OWNER) |
| Authorized Official Contact | 3137685096 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifesmart Medical Center Pllc 2176 Fort St Lincoln Park MI 48146-2405 Ph: (313) 768-5096 | Lifesmart Medical Center Pllc 2176 Fort St Lincoln Park MI 48146-2405 Ph: (313) 768-5096 |
| NPI Number | 1477391274 |
|---|---|
| Provider Enumeration Date | 07/16/2024 |
| Last Update Date | 08/12/2025 |
| Medicare PECOS PAC ID | 5193263143 |
|---|---|
| Medicare Enrollment ID | O20240821002498 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477391274 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Amitha Parvataneni |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336326362 PECOS PAC ID: 8628219441 Enrollment ID: I20200206000914 |
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