| Lake Erie College Of Osteopathic Medicine | |
|
2828 S Mccall Rd Ste 21 Englewood FL 34224-9517 | |
| (941) 474-8154 | |
| Not Available |
| Full Name | Lake Erie College Of Osteopathic Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 2828 S Mccall Rd Ste 21, Englewood, Florida |
| Authorized Official Name and Position | Tatiana Robles (CREDENTIALING COORIDATOR) |
| Authorized Official Contact | 2393485080 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Erie College Of Osteopathic Medicine 2828 S Mccall Rd Ste 21 Englewood FL 34224-9517 Ph: (941) 474-8154 | Lake Erie College Of Osteopathic Medicine 2828 S Mccall Rd Ste 21 Englewood FL 34224-9517 Ph: (941) 474-8154 |
| NPI Number | 1467087296 |
|---|---|
| Provider Enumeration Date | 03/12/2020 |
| Last Update Date | 03/12/2020 |
| Medicare PECOS PAC ID | 7719141472 |
|---|---|
| Medicare Enrollment ID | O20200511002017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467087296 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Joseph P Coppola |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013969583 PECOS PAC ID: 6002702321 Enrollment ID: I20130920000599 |
| Provider Name | Diana Kay Perrin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730734138 PECOS PAC ID: 6800202706 Enrollment ID: I20210301001012 |
| Provider Name | Constance W Strbich |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033148978 PECOS PAC ID: 7113061151 Enrollment ID: I20211228000470 |
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