MEDICARE: THOMAS ALEXANDER LEKAVICH PA

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	363A00000X	Physician Assistant	PA9102189	FL
2	363AM0700X	Medical Physician Assistant	PA9102189	FL

General Provider Information

NPI Number	:	1063465623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS ALEXANDER LEKAVICH PA

Provider Business Mailing Address
First Line	:	1601 W REYNOLDS ST STE 104
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-4708
Country	:	US
Telephone Number	:	813-709-8567
Fax Number	:	215-642-8552

Provider Business Practice Location Address
First Line	:	13021 W LINEBAUGH AVE STE 102
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-4509
Country	:	US
Telephone Number	:	813-709-8567
Fax Number	:	215-642-8552

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	02/16/2024

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