| Lakeside Medical Llc | |
|
600 N Hiatus Rd Ste 203 Pembroke Pines FL 33026-5207 | |
| (954) 392-7157 | |
| (954) 443-4941 |
| Full Name | Lakeside Medical Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 600 N Hiatus Rd Ste 203, Pembroke Pines, Florida |
| Authorized Official Name and Position | Armando De Feria (PRESIDENT) |
| Authorized Official Contact | 9543927157 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Medical Llc 600 N Hiatus Rd Ste 203 Pembroke Pines FL 33026-5207 Ph: (954) 392-7157 | Lakeside Medical Llc 600 N Hiatus Rd Ste 203 Pembroke Pines FL 33026-5207 Ph: (954) 392-7157 |
| NPI Number | 1356820286 |
|---|---|
| Provider Enumeration Date | 08/10/2018 |
| Last Update Date | 08/10/2018 |
| Medicare PECOS PAC ID | 4789919028 |
|---|---|
| Medicare Enrollment ID | O20190709003017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356820286 | NPI | - | NPPES |
| NONE | Other | NONE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Jennifer Nieves-cunningham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700825601 PECOS PAC ID: 7810098068 Enrollment ID: I20070718000649 |
| Provider Name | Armando A De Feria |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639179807 PECOS PAC ID: 5193896223 Enrollment ID: I20080915000083 |
| Provider Name | Megan Janson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366738478 PECOS PAC ID: 1355589680 Enrollment ID: I20130529000135 |
| Provider Name | Tyesha Bowen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629440516 PECOS PAC ID: 7012255102 Enrollment ID: I20190215000203 |
| Provider Name | Lisset Gonzalez Perez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659953610 PECOS PAC ID: 4284894676 Enrollment ID: I20210927002939 |
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