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General NPI Number Information
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NPI Number | 1548981947
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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 | 09/06/2022
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 1404 S RIDGEWOOD AVE
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City | EDGEWATER
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State | FL
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Zip | 32132-2720
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Country | US
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Telephone | 386-265-5926
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Fax | 386-265-5928
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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 | 386-258-9443
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | KATHLEEN 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 | 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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