GLENDALE WEIGHTLOSS LLC
Osteopathic Medicine at Thunderbird Rd, Glendale, AZ

License number
Arizona 500010862
Category
Osteopathic Medicine
Type
Obesity Medicine
Owner
Name: EDWARD KALOUST
Title: MANAGER MEMBER
Phone: (813) 228-6334
Address
Address 2
5310 W Thunderbird Rd STE 308, Glendale, AZ 85306
509 S Hyde Park Ave, Tampa, FL 33606
National Provider ID: 1376925602
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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GLENDALE WEIGHTLOSS, LLC

Glendale, AZ  -  Tampa, FL

Registration:
May 23, 2013
Addresses:
Ste 30 STE 308, Glendale, AZ 85306 (Physical)
509 S Hyde Park Ave, Tampa, FL 33606 (Foreign)
State ID:
R-1849208-4
Business type:
Florida Limited Liability
Managing Members:
Physician's Health Mgmnt Llc (Manager), 509 S Hyde Park Ave, Tampa, FL 33606 (Physical),Jtg Wt Mgmnt Ventures Llc (Member), Ste 30 STE 308, Glendale, AZ 85306 (Physical),Physician's Health Management, Inc (Managing Member)
Agent:
Incorp Services Inc,2338 W Royal Palm Rd STE J, Phoenix, AZ 85021 (Physical)

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