| Favilli Family Practice Center | |
|
3650 Innovation Dr Lakeland FL 33812-4105 | |
| (863) 646-6295 | |
| (863) 701-2151 |
| Full Name | Favilli Family Practice Center |
|---|---|
| Speciality | Family Medicine |
| Location | 3650 Innovation Dr, Lakeland, Florida |
| Authorized Official Name and Position | Luis C Favilli (FAMILY PRACTICE) |
| Authorized Official Contact | 8632857171 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Favilli Family Practice Center 6675 Westwood Blvd Ste 475 Orlando FL 32821-8061 Ph: (407) 845-0330 | Favilli Family Practice Center 3650 Innovation Dr Lakeland FL 33812-4105 Ph: (863) 646-6295 |
| NPI Number | 1336321835 |
|---|---|
| Provider Enumeration Date | 11/27/2007 |
| Last Update Date | 04/27/2017 |
| Medicare PECOS PAC ID | 8123102704 |
|---|---|
| Medicare Enrollment ID | O20080220000501 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336321835 | NPI | - | NPPES |
| E49325 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME0056610 (Florida) | Primary |
| Provider Name | Luis C Favilli |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013912625 PECOS PAC ID: 8820172406 Enrollment ID: I20080227000289 |
Adult Primary Care Of Polk County Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4740 Exploration Ave, Lakeland, FL 33812 Phone: 863-666-9020 Fax: 863-606-0887 | |
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Premier Walk In Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5676 S Florida Ave, Lakeland, FL 33813 Phone: 863-644-3400 Fax: 863-619-2400 | |
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