| Lake Endocrinology Consulting, Pllc | |
|
13123 66th St Largo FL 33773-1812 | |
| (727) 477-1039 | |
| (727) 477-0498 |
| Full Name | Lake Endocrinology Consulting, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 13123 66th St, Largo, Florida |
| Authorized Official Name and Position | Brian Matthew Lake (AMBR) |
| Authorized Official Contact | 7274771039 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Endocrinology Consulting, Pllc 13123 66th St Largo FL 33773-1812 Ph: (727) 477-1039 | Lake Endocrinology Consulting, Pllc 13123 66th St Largo FL 33773-1812 Ph: (727) 477-1039 |
| NPI Number | 1619418563 |
|---|---|
| Provider Enumeration Date | 03/12/2017 |
| Last Update Date | 05/02/2021 |
| Medicare PECOS PAC ID | 2668746827 |
|---|---|
| Medicare Enrollment ID | O20170927000354 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619418563 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (* (Not Available)) | Primary |
| 261QM2500X | Clinic/center - Medical Specialty | OS9591 (Florida) | Secondary |
| Provider Name | Kimberley J Philip |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538130919 PECOS PAC ID: 3173616489 Enrollment ID: I20070831000507 |
| Provider Name | Brian M Lake |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1295887040 PECOS PAC ID: 0840343455 Enrollment ID: I20090729000759 |
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