Healthcare Provider Details

I. General information

NPI: 1396391033
Provider Name (Legal Business Name): ACCESS MEDICAL GROUP OF LAKELAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5615 S FLORIDA AVE STE 111
LAKELAND FL
33813-2714
US

IV. Provider business mailing address

6100 BLUE LAGOON DR STE 365
MIAMI FL
33126-7010
US

V. Phone/Fax

Practice location:
  • Phone: 863-327-0132
  • Fax: 863-777-2320
Mailing address:
  • Phone: 786-208-3237
  • Fax: 786-322-7329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYNY RAMIREZ
Title or Position: PRESIDENT
Credential:
Phone: 786-322-7333