| Palm Medical Center Lakeland Llc | |
|
11017 N Dale Mabry Hwy Ste B Tampa FL 33618-3873 | |
| (813) 337-7402 | |
| (813) 461-6462 |
| Full Name | Palm Medical Center Lakeland Llc |
|---|---|
| Speciality | General Practice |
| Location | 11017 N Dale Mabry Hwy Ste B, Tampa, Florida |
| Authorized Official Name and Position | Santiago Moises Martin (PRESIDENT OF CENTER OPERATIONS) |
| Authorized Official Contact | 3059139441 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Palm Medical Center Lakeland Llc 2600 S Douglas Rd Ste 308 Coral Gables FL 33134-6134 Ph: (813) 538-7880 | Palm Medical Center Lakeland Llc 11017 N Dale Mabry Hwy Ste B Tampa FL 33618-3873 Ph: (813) 337-7402 |
| NPI Number | 1073249348 |
|---|---|
| Provider Enumeration Date | 07/28/2022 |
| Last Update Date | 07/28/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073249348 | NPI | - | NPPES |
| 016289500 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
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