| Lake Prime Care | |
|
33041 Professional Dr Suite 101 Leesburg FL 34788-3760 | |
| (352) 365-1224 | |
| (352) 365-0786 |
| Full Name | Lake Prime Care |
|---|---|
| Speciality | Internal Medicine |
| Location | 33041 Professional Dr, Leesburg, Florida |
| Authorized Official Name and Position | Weena C Favis (OWNER) |
| Authorized Official Contact | 3523651224 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Prime Care 33041 Professional Dr Suite 101 Leesburg FL 34788-3760 Ph: (352) 365-1224 | Lake Prime Care 33041 Professional Dr Suite 101 Leesburg FL 34788-3760 Ph: (352) 365-1224 |
| NPI Number | 1235194861 |
|---|---|
| Provider Enumeration Date | 04/18/2006 |
| Last Update Date | 03/15/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235194861 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 203BI03004 (Florida) | Primary |
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