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General NPI Number Information
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NPI Number | 1609155464
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Entity Type | Organization
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Legal Business Name | LAKESIDE OF LAKELAND
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Dates
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Enumeration Date | 08/11/2011
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Last Update Date | 08/11/2011
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Provider Practice Location Address
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Address Line | 1750 N BROADWAY AVE
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City | BARTOW
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State | FL
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Zip | 33830-3103
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Country | US
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Telephone | 863-533-2030
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Fax |
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Provider Business Mailing Address
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Address Line | 1750 N BROADWAY AVE
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City | BARTOW
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State | FL
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Zip | 33830-3103
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP OPERATIONS
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Name | MRS. ARLENE GUZIK
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Credential | ARNP
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Telephone | 727-532-7644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | ME 25396
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License Number State | FL
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