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NPI Code Detail

MEDICARE: LEWIS & KLANCKE CARDIOLOGY, P.A.

MEDICARE: LEWIS & KLANCKE CARDIOLOGY, P.A.
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
1207RC0000XCardiovascular Disease Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
299279OTHERFLMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548981947
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEWIS & KLANCKE CARDIOLOGY, P.A.
Provider Business Mailing Address
First Line : 695 N CLYDE MORRIS BLVD
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32114-2321
Country : US
Telephone Number : 386-258-8722
Fax Number : 386-258-9443
Provider Business Practice Location Address
First Line : 1404 S RIDGEWOOD AVE
Second Line :
City : EDGEWATER
State : FL
Zip : 32132-2720
Country : US
Telephone Number : 386-265-5926
Fax Number : 386-265-5928
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : KATHLEEN T PHILLIPS
Credential :
Telephone Number : 386-258-8722
Provider Enumeration Date : 09/06/2022
Last Update Date : 10/03/2023

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