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General NPI Number Information
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NPI Number | 1164560041
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Entity Type | Organization
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Legal Business Name | LEWIS & KLANCKE CARDIOLOGY, P.A.
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 630 W PLYMOUTH AVE
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City | DELAND
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State | FL
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Zip | 32720-3260
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Country | US
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Telephone | 386-734-3654
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Fax | 386-943-8087
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Provider Business Mailing Address
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Address Line | 695 N CLYDE MORRIS BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2321
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Country | US
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Telephone | 386-258-8722
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Fax | 386-258-8659
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | KATHY T PHILLIPS
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Credential |
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Telephone | 386-258-8722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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