| Lake Medical Group, Llc | |
|
14750 Nw 77th Ct Ste 304 Miami Lakes FL 33016-1537 | |
| (305) 507-4400 | |
| (305) 826-2840 |
| Full Name | Lake Medical Group, Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 14750 Nw 77th Ct Ste 304, Miami Lakes, Florida |
| Authorized Official Name and Position | Alfonso Gonzalez (PRESIDENT/OWNER) |
| Authorized Official Contact | 3058014030 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Medical Group, Llc 14750 Nw 77th Ct Ste 304 Miami Lakes FL 33016-1537 Ph: (305) 507-4400 | Lake Medical Group, Llc 14750 Nw 77th Ct Ste 304 Miami Lakes FL 33016-1537 Ph: (305) 507-4400 |
| NPI Number | 1437448354 |
|---|---|
| Provider Enumeration Date | 03/31/2011 |
| Last Update Date | 08/03/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437448354 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (Florida) | Primary |
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