Healthcare Provider Details

I. General information

NPI: 1770201063
Provider Name (Legal Business Name): AESCULAP MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 NORTHSIDE DR UNIT 601
PANAMA CITY FL
32405-3687
US

IV. Provider business mailing address

2101 NORTHSIDE DR UNIT 601
PANAMA CITY FL
32405-3687
US

V. Phone/Fax

Practice location:
  • Phone: 850-215-5310
  • Fax: 850-215-0159
Mailing address:
  • Phone: 850-215-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRZYSZTOF T LEWANDOWSKI
Title or Position: OWNER
Credential: MD
Phone: 850-215-5310