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General NPI Number Information
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NPI Number | 1174564553
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Entity Type | Organization
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Legal Business Name | LAKELAND PHYSICIANS GROUP LLC
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 517 BUENA VISTA ST.
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City | LAKELAND
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State | FL
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Zip | 33805
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Country | US
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Telephone | 863-688-3674
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Fax | 863-616-9902
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Provider Business Mailing Address
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Address Line | PO BOX 150038
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32715-0038
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Country | US
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Telephone | 407-782-3702
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Fax | 863-648-9520
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN PHILIP NIMBARGI
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Credential | MD
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Telephone | 407-782-3702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME85807
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME92618
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine 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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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