| Lyle E Wadsworth Md Pa | |
|
890 N Boundary Ave Ste 102 Deland FL 32720-3173 | |
| (386) 740-0224 | |
| Not Available |
| Full Name | Lyle E Wadsworth Md Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 890 N Boundary Ave Ste 102, Deland, Florida |
| Authorized Official Name and Position | Lyle E. Wadsworth (PRESIDENT) |
| Authorized Official Contact | 3867400224 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lyle E Wadsworth Md Pa 890 N Boundary Ave Ste 102 Deland FL 32720-3173 Ph: (386) 740-0224 | Lyle E Wadsworth Md Pa 890 N Boundary Ave Ste 102 Deland FL 32720-3173 Ph: (386) 740-0224 |
| NPI Number | 1205018207 |
|---|---|
| Provider Enumeration Date | 11/30/2007 |
| Last Update Date | 03/06/2008 |
| Medicare PECOS PAC ID | 6709960537 |
|---|---|
| Medicare Enrollment ID | O20080303000563 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205018207 | NPI | - | NPPES |
| 64391 | Other | FL | BLUE CROSS BLUE SHIELD |
| 000050266105 | Other | FL | UNITEDHEALTHCARE |
| 5490138 | Other | FL | AETNA |
| 2198298007 | Other | FL | CIGNA |
| Provider Name | Lyle E Wadsworth |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356347561 PECOS PAC ID: 6709969140 Enrollment ID: I20080208000259 |
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