| Organization Name: | NEW LIFE MEDICAL, LLC |
| NPI Number: | 1841570512 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRENT R KORN (MEDICAL DIRECTOR) |
| Mailing Address: | 2915 E Baseline Rd Ste 105 Gilbert |
| State: | AZ US |
| Postal Code: | 852342427 |
| Phone Number: | 4803546700 |
| Fax Number: | 4803546708 |
| NPI Enumeration Date: | 08/25/2011 |
| NPI Last Update Date: | 08/25/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 109213 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |