Provider Demographics
NPI:1669357737
Name:LIFELINE MEDICAL GROUP
Entity type:Organization
Organization Name:LIFELINE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED SIGNATORY
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVNEET
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-321-3121
Mailing Address - Street 1:3901 HIGHLAND RD STE A
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-2162
Mailing Address - Country:US
Mailing Address - Phone:248-321-3121
Mailing Address - Fax:
Practice Address - Street 1:3901 HIGHLAND RD STE A
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2162
Practice Address - Country:US
Practice Address - Phone:248-321-3121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty