Healthcare Provider Details

I. General information

NPI: 1831682814
Provider Name (Legal Business Name): LAKE ALLERGY, ASTHMA AND IMMUNOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1822 SALK AVE
TAVARES FL
32778-4300
US

IV. Provider business mailing address

1936 SALK AVE
TAVARES FL
32778-4310
US

V. Phone/Fax

Practice location:
  • Phone: 525-531-7173
  • Fax: 888-220-7924
Mailing address:
  • Phone: 954-609-0140
  • Fax: 888-220-7924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME118840
License Number StateFL

VIII. Authorized Official

Name: DR. ANDREW J COOKE
Title or Position: PRESIDENT
Credential: MD
Phone: 954-609-0140