institution
Lake Wale Pediatric Internal Medicine P.a.
Primary Care Clinic/Center in Lake Wales, Florida
NPI 1831362805

Lake Wale Pediatric Internal Medicine P.a. is a Primary Care Clinic/Center based in Lake Wales, FL and is specialized in Primary Care. Lake Wale Pediatric Internal Medicine P.a. practices in Lake Wales, FL. The NPI Number for Lake Wale Pediatric Internal Medicine P.a. is 1831362805 and holds a License No. ME87271-ME90317 (Florida).

The current practice location address for Lake Wale Pediatric Internal Medicine P.a. is 425 S 11Th St, Lake Wales, FL and can be reached out via phone at 863-676-8935 and via fax at 863-679-2691.

Location: 425 S 11Th St, Lake Wales, FL, 33853-4239
institution
Provider Profile Details
NPI Number
1831362805
Provider Name
Lake Wale Pediatric Internal Medicine P.a.
Credential
Provider Entity Type
Organization
Address
425 S 11Th St, Lake Wales, FL, 33853-4239
Phone Number
863-676-8935
Fax Number
863-679-2691
Provider Enumeration Date
04/10/2008
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
AL 597 01 FL MEDICARE PROVIDER GROUP
institution
Provider Business Practice Location Address Details
Address
425 S 11Th St
City
State
Zip
33853-4239
Phone Number
863-676-8935
Fax Number
863-679-2691
person
Provider Business Mailing Address Details
Address
425 S 11Th St
City
State
Zip
33853-4239
Phone Number
863-676-8935
Fax Number
863-679-2691
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Primary Care
Taxonomy
License No.
ME87271-ME90317 (Florida)
Definition
Definition to come...
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