Healthcare Provider Details

I. General information

NPI: 1598194326
Provider Name (Legal Business Name): LAKE WHITNEY PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 11/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 NW LAKE WHITNEY PL STE 103
PORT ST LUCIE FL
34986-1622
US

IV. Provider business mailing address

579 NW LAKE WHITNEY PL STE 103
PORT ST LUCIE FL
34986-1622
US

V. Phone/Fax

Practice location:
  • Phone: 772-249-5423
  • Fax: 772-249-5347
Mailing address:
  • Phone: 772-249-5423
  • Fax: 772-249-5347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DUSAN LEKIC
Title or Position: OWNER
Credential: M.D.
Phone: 772-249-5423