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General NPI Number Information
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NPI Number | 1710285796
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Entity Type | Organization
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Legal Business Name | SAINT CLARES MEDICAL CLINIC
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Dates
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Enumeration Date | 03/01/2011
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Last Update Date | 03/01/2011
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Provider Practice Location Address
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Address Line | 5131 S FLORIDA AVE SUITE 1
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City | LAKELAND
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State | FL
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Zip | 33813-2514
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Country | US
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Telephone | 863-937-8991
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Fax | 863-937-8992
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Provider Business Mailing Address
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Address Line | 5131 S FLORIDA AVE SUITE 1
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City | LAKELAND
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State | FL
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Zip | 33813-2514
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Country | US
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Telephone | 863-937-8991
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Fax | 863-937-8992
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. LILIAN C AKAGBOSU
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Credential | MD
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Telephone | 863-937-8991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 94416
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License Number State | FL
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