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NPI Code Detail

MEDICARE: SLEZAK COLORECTAL SURGICAL CLINIC

MEDICARE: SLEZAK COLORECTAL SURGICAL CLINIC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistME93310FL

General Provider Information

NPI Number : 1346406246
Entity Type Code : Organization
Provider Name (Legal Business Name) : SLEZAK COLORECTAL SURGICAL CLINIC
Provider Business Mailing Address
First Line : 4814 N HABANA AVE
Second Line :
City : TAMPA
State : FL
Zip : 33614-6871
Country : US
Telephone Number : 813-873-2650
Fax Number : 813-873-2690
Provider Business Practice Location Address
First Line : 4814 N HABANA AVE
Second Line :
City : TAMPA
State : FL
Zip : 33614-6871
Country : US
Telephone Number : 813-873-2650
Fax Number : 813-873-2690
Authorized Official
Title or Position : OWNER
Name : DR. LORI SLEZAK
Credential : M.D.
Telephone Number : 813-873-2650
Provider Enumeration Date : 07/31/2008
Last Update Date : 04/08/2013

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Directions to “SLEZAK COLORECTAL SURGICAL CLINIC ” Practice Location

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