MEDICARE: LAKE MEDICAL IMAGING AND BREAST CENTER AT THE VILLAGES LLC

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
1	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770541633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE MEDICAL IMAGING AND BREAST CENTER AT THE VILLAGES LLC

Provider Business Mailing Address
First Line	:	734 N 3RD ST
Second Line	:	SUITE 115
City	:	LEESBURG
State	:	FL
Zip	:	34748-5285
Country	:	US
Telephone Number	:	352-365-2583
Fax Number	:	352-728-6749

Provider Business Practice Location Address
First Line	:	801 E DIXIE AVE STE 104
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-7601
Country	:	US
Telephone Number	:	352-787-5858
Fax Number	:	352-787-4655

Authorized Official
Title or Position	:	DIRECTOR OF RISK MANAGEMENT
Name	:	MR. JOSH L FLOYD
Credential	:
Telephone Number	:	352-365-2583

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	06/23/2021

Similar Medicare Providers

1518940147 — DR. DAVID LEE FACTOR M.D.
Practice Location Address:

801 E DIXIE AVE STE 104
LEESBURG, FL
34748-7601

Practice Phone: 352-787-5858
Practice Fax: 352-787-4655

1275593311 — STEPHEN Z. GRAHOVAC MD
Practice Location Address:

801 E DIXIE AVE STE 104
LEESBURG, FL
34748-7601

Practice Phone: 352-787-5858
Practice Fax: 352-787-4655

1063478592 — DR. MICHAEL S LEVINE M.D.
Practice Location Address:

801 E DIXIE AVE , SUITE 104
LEESBURG, FL
34748-7601

Practice Phone: 352-365-2583
Practice Fax: 352-728-6749

1528026317 — DR. DAVID CHRISTOPHER WEYN M.D.
Practice Location Address:

801 E DIXIE AVE , SUITE 104
LEESBURG, FL
34748-7601

Practice Phone: 352-365-2583
Practice Fax: 352-728-6749

1447218201 — DR. MAHRAD PAYMANI M.D.
Practice Location Address:

801 E DIXIE AVE , SUITE 104
LEESBURG, FL
34748-7601

Practice Phone: 352-365-2583
Practice Fax: 352-728-6749

1114975281 — DR. MANOJ BHATIA M.D.
Practice Location Address:

801 E DIXIE AVE , SUITE 104
LEESBURG, FL
34748-7601

Practice Phone: 352-365-2583
Practice Fax: 352-728-6749

Directions to “LAKE MEDICAL IMAGING AND BREAST CENTER AT THE VILLAGES LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.