| Dpn-fl Pa | |
|
13517 Deep Blue Pl Bradenton FL 34211-4129 | |
| (313) 329-2646 | |
| Not Available |
| Full Name | Dpn-fl Pa |
|---|---|
| Speciality | General Practice |
| Location | 13517 Deep Blue Pl, Bradenton, Florida |
| Authorized Official Name and Position | Dominick Lago (PRESIDENT) |
| Authorized Official Contact | 2486319171 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dpn-fl Pa 13517 Deep Blue Pl Bradenton FL 34211-4129 Ph: () - | Dpn-fl Pa 13517 Deep Blue Pl Bradenton FL 34211-4129 Ph: (313) 329-2646 |
| NPI Number | 1750089728 |
|---|---|
| Provider Enumeration Date | 02/20/2023 |
| Last Update Date | 02/20/2023 |
| Medicare PECOS PAC ID | 3173988052 |
|---|---|
| Medicare Enrollment ID | O20230427002478 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750089728 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Daniel Lawrence Wolfson |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1124230958 PECOS PAC ID: 1355435140 Enrollment ID: I20070925000167 |
| Provider Name | Dominick Lago |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1013950880 PECOS PAC ID: 0042108193 Enrollment ID: I20230216002845 |
| Provider Name | Meaghan Judge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346702800 PECOS PAC ID: 4183085152 Enrollment ID: I20230807003798 |
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