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NPI Code Detail

MEDICARE: LAKE COUNTY ONCOLOGY AND HEMATOLOGY

MEDICARE: LAKE COUNTY ONCOLOGY AND HEMATOLOGY
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
1207RH0003XHematology & Oncology Physician06000041448FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518923408
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKE COUNTY ONCOLOGY AND HEMATOLOGY
Provider Business Mailing Address
First Line : PO BOX 741240
Second Line :
City : ORANGE CITY
State : FL
Zip : 32774-1240
Country : US
Telephone Number : 386-774-5211
Fax Number : 386-774-5251
Provider Business Practice Location Address
First Line : 4100 WATERMAN WAY
Second Line :
City : TAVARES
State : FL
Zip : 32778-5270
Country : US
Telephone Number : 386-774-5211
Fax Number : 386-774-5251
Authorized Official
Title or Position : PRESIDENT
Name : ROY M AMBINDER
Credential : M. D.
Telephone Number : 386-774-5211
Provider Enumeration Date : 04/21/2006
Last Update Date : 04/13/2012

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Directions to “LAKE COUNTY ONCOLOGY AND HEMATOLOGY ” Practice Location

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