Healthcare Provider Details

I. General information

NPI: 1487684528
Provider Name (Legal Business Name): DAVID M GONDEK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13696 N US HIGHWAY 441
LADY LAKE FL
32159-6814
US

IV. Provider business mailing address

13696 N US HIGHWAY 441
LADY LAKE FL
32159-6814
US

V. Phone/Fax

Practice location:
  • Phone: 352-775-1221
  • Fax: 866-531-8528
Mailing address:
  • Phone: 352-775-1221
  • Fax: 866-531-8528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1860
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA1860
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 1860
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: