MEDICARE: LAKE MARY FAMILY MEDICINE, INC.

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1881631778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE MARY FAMILY MEDICINE, INC.

Provider Business Mailing Address
First Line	:	320 W SABAL PALM PL
Second Line	:	SUITE 300
City	:	LONGWOOD
State	:	FL
Zip	:	32779-3639
Country	:	US
Telephone Number	:	407-260-1137
Fax Number	:	407-332-7893

Provider Business Practice Location Address
First Line	:	109 TIMBERLACHEN CIR
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3395
Country	:	US
Telephone Number	:	407-333-9877
Fax Number	:	407-333-9881

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. SUREE VYAS
Credential	:
Telephone Number	:	407-830-1975

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	10/20/2010

Similar Medicare Providers

1508859299 — DR. GLENDA E. GONZALEZ-COUVERTIER M.D.
Practice Location Address:

109 TIMBERLACHEN CIR
LAKE MARY, FL
32746-3395

Practice Phone: 407-333-9877
Practice Fax: 407-333-9881

1093760829 — DR. DURGABHAVANI B VALAY M.D
Practice Location Address:

109 TIMBERLACHEN CIR
LAKE MARY, FL
32746-3395

Practice Phone: 407-880-0011
Practice Fax: 407-880-7792

1437197399 — DR. HELEN ELENA SIMPSON M.D
Practice Location Address:

109 TIMBERLACHEN CIR
LAKE MARY, FL
32746-3395

Practice Phone: 407-333-9877
Practice Fax: 407-333-9881

1366466286 — DR. ELLIS LAMAR FULLER D.D.S
Practice Location Address:

114 TIMBERLACHEN CIR
LAKE MARY, FL
32746-3395

Practice Phone: 407-330-3801
Practice Fax: 407-330-5739

1154427292 — DR. DEAN ALLEN GOODALL DDS
Practice Location Address:

114 TIMBERLACHEN CIR
LAKE MARY, FL
32746-3395

Practice Phone: 407-330-3801
Practice Fax: 407-330-5739

1144382623 — MS. KRISTINE ROBERTA ILGENFRITZ PAC
Practice Location Address:

109 TIMBERLACHEN CIR
LAKE MARY, FL
32746-3395

Practice Phone: 407-333-9877
Practice Fax: 407-333-9881

Directions to “LAKE MARY FAMILY MEDICINE, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.