Healthcare Provider Details

I. General information

NPI: 1003969437
Provider Name (Legal Business Name): LAKEWOOD CARDIOVASCULAR CONSULTANTS P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6310 HEALTH PARK WAY SUITE 230
BRADENTON FL
34202-5177
US

IV. Provider business mailing address

6310 HEALTH PARK WAY SUITE 230
BRADENTON FL
34202-5177
US

V. Phone/Fax

Practice location:
  • Phone: 941-907-1113
  • Fax: 941-907-3887
Mailing address:
  • Phone: 941-907-1113
  • Fax: 941-907-3887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME77684
License Number StateFL

VIII. Authorized Official

Name: ERICK E CALDERON
Title or Position: OWNER
Credential: MD
Phone: 941-907-1113