MEDICARE: LAKEWOOD PARK WALK-IN CLINIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1013959394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEWOOD PARK WALK-IN CLINIC, LLC

Provider Business Mailing Address
First Line	:	5059 TURNPIKE FEEDER RD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-2246
Country	:	US
Telephone Number	:	772-465-8588
Fax Number	:

Provider Business Practice Location Address
First Line	:	5059 TURNPIKE FEEDER RD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-2246
Country	:	US
Telephone Number	:	772-465-8588
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	CRAIG WALKER
Credential	:
Telephone Number	:	772-465-8588

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	08/22/2020

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