Provider Demographics
NPI:1902529753
Name:SUSTAINABLE LIFESTYLE AND METABOLIC CLINIC INC
Entity Type:Organization
Organization Name:SUSTAINABLE LIFESTYLE AND METABOLIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KOFI
Authorized Official - Middle Name:
Authorized Official - Last Name:SARFO-KANTANKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-819-7386
Mailing Address - Street 1:301 WEST AVE APT 4302
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4763
Mailing Address - Country:US
Mailing Address - Phone:503-819-7386
Mailing Address - Fax:
Practice Address - Street 1:301 WEST AVE APT 4302
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-4763
Practice Address - Country:US
Practice Address - Phone:503-819-7386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Single Specialty