| Light Matter Solutions Llc | |
|
333 E 2nd St Richland Center WI 53581-1914 | |
| (702) 453-3799 | |
| (702) 453-5741 |
| Full Name | Light Matter Solutions Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 333 E 2nd St, Richland Center, Wisconsin |
| Authorized Official Name and Position | Jacob Kalliath (SOLE OWNER) |
| Authorized Official Contact | 2568102308 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Light Matter Solutions Llc 2660 Crimson Canyon Dr Ste 130 Las Vegas NV 89128-0846 Ph: (702) 453-3799 | Light Matter Solutions Llc 333 E 2nd St Richland Center WI 53581-1914 Ph: (702) 453-3799 |
| NPI Number | 1457816332 |
|---|---|
| Provider Enumeration Date | 02/05/2019 |
| Last Update Date | 02/05/2019 |
| Medicare PECOS PAC ID | 1850633231 |
|---|---|
| Medicare Enrollment ID | O20190509001715 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457816332 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Jacob A Kalliath |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134569395 PECOS PAC ID: 4486947421 Enrollment ID: I20170119002900 |
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