Healthcare Provider Details

I. General information

NPI: 1093975062
Provider Name (Legal Business Name): LAKEWOOD RANCH MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8340 LAKEWOOD RANCH BLVD SUITE 140
LAKEWOOD RANCH FL
34202-5180
US

IV. Provider business mailing address

PO BOX 281741
ATLANTA GA
30384-1741
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-2800
  • Fax: 941-782-2513
Mailing address:
  • Phone: 941-782-2800
  • Fax: 941-782-2513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CECILIA D CARAG
Title or Position: DELEGATED OFFICER
Credential: MD
Phone: 941-782-2800