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General NPI Number Information
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NPI Number | 1598065153
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Entity Type | Organization
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Legal Business Name | LAKE DRIVE MEDICAL, LLC
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Dates
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Enumeration Date | 10/29/2010
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Last Update Date | 06/25/2013
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Provider Practice Location Address
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Address Line | 2675 LAKE DR
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-3813
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Country | US
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Telephone | 561-748-2889
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Fax | 561-748-1523
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Provider Business Mailing Address
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Address Line | 5220 HOOD RD SUITE 101
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-8910
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Country | US
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Telephone | 561-748-2889
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Fax | 561-748-1523
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Authorized Official
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Title or Position | PRESIDENT, JUPITER PROFESSIONAL DEV
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Name | KAREN BARLOW
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Credential |
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Telephone | 561-748-2889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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