Healthcare Provider Details

I. General information

NPI: 1386961894
Provider Name (Legal Business Name): LAKESIDE OF ORLANDO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2314 N ORANGE BLOSSOM TRL
ORLANDO FL
32804-4803
US

IV. Provider business mailing address

7527 ULMERTON RD
LARGO FL
33771-4548
US

V. Phone/Fax

Practice location:
  • Phone: 407-428-9233
  • Fax: 407-428-9667
Mailing address:
  • Phone: 727-586-0138
  • Fax: 727-586-6954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License NumberME25396
License Number StateFL

VIII. Authorized Official

Name: ARLENE GUZIK
Title or Position: VP OPERATION, ASSISTANT MEDICAL DIR
Credential:
Phone: 727-532-7644