MEDICARE: LAKE COUNTY NEUROSURGICALAND SPINAL INSTITUTE

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	207T00000X	Neurological Surgery Physician	ME68960	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC0018	OTHER	FL	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1831369792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE COUNTY NEUROSURGICALAND SPINAL INSTITUTE

Provider Business Mailing Address
First Line	:	704 DOCTORS CT
Second Line	:	SUITE 101
City	:	LEESBURG
State	:	FL
Zip	:	34748-7366
Country	:	US
Telephone Number	:	352-728-3252
Fax Number	:	352-728-1320

Provider Business Practice Location Address
First Line	:	704 DOCTORS CT
Second Line	:	SUITE 101
City	:	LEESBURG
State	:	FL
Zip	:	34748-7366
Country	:	US
Telephone Number	:	352-728-3252
Fax Number	:	352-728-1320

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL G. HILL
Credential	:	M.D.
Telephone Number	:	352-728-3252

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	05/29/2013

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