| Lake Family Medicine & Imaging | |
|
1403 Medical Plaza Dr Ste 100 Sanford FL 32771-1085 | |
| (407) 559-5100 | |
| (407) 559-5110 |
| Full Name | Lake Family Medicine & Imaging |
|---|---|
| Speciality | Family Medicine |
| Location | 1403 Medical Plaza Dr Ste 100, Sanford, Florida |
| Authorized Official Name and Position | Raj Kandavanam (OWNER) |
| Authorized Official Contact | 4075595100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Family Medicine & Imaging 1403 Medical Plaza Dr Ste 100 Sanford FL 32771-1085 Ph: (407) 559-5100 | Lake Family Medicine & Imaging 1403 Medical Plaza Dr Ste 100 Sanford FL 32771-1085 Ph: (407) 559-5100 |
| NPI Number | 1164018743 |
|---|---|
| Provider Enumeration Date | 12/17/2020 |
| Last Update Date | 12/17/2020 |
| Medicare PECOS PAC ID | 8527472307 |
|---|---|
| Medicare Enrollment ID | O20210208001240 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164018743 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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