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General NPI Number Information
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NPI Number | 1952585796
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Entity Type | Organization
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Legal Business Name | FAMILY PHYSICIANS OF KENDALL LLC
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 11160 SW 88TH ST SUITE #104 & #105
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City | MIAMI
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State | FL
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Zip | 33176-0949
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Country | US
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Telephone | 786-263-0911
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Fax | 786-263-2761
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Provider Business Mailing Address
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Address Line | 11160 SW 88TH ST SUITE #104 & #105
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City | MIAMI
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State | FL
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Zip | 33176-0949
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Country | US
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Telephone | 786-263-0911
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Fax | 786-263-2761
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Authorized Official
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Title or Position | OWNER
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Name | NORMA S LAKE
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Credential | M.D.
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Telephone | 786-263-0911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME 81467
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License Number State | FL
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