Healthcare Provider Details

I. General information

NPI: 1003151903
Provider Name (Legal Business Name): LPS MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 N MAIN ST STE 105
KISSIMMEE FL
34744-4244
US

IV. Provider business mailing address

1310 N MAIN ST STE 105
KISSIMMEE FL
34744-4244
US

V. Phone/Fax

Practice location:
  • Phone: 407-483-7975
  • Fax: 888-772-5242
Mailing address:
  • Phone: 407-483-7975
  • Fax: 888-772-5242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME107498
License Number StateFL

VIII. Authorized Official

Name: DR. CRUZ ADELMIS SANTOS
Title or Position: PHYSICIAN
Credential: MD
Phone: 407-476-4011