Provider Demographics
NPI:1063465623
Name:LEKAVICH, THOMAS ALEXANDER (PA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALEXANDER
Last Name:LEKAVICH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 W REYNOLDS ST STE 104
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-4708
Mailing Address - Country:US
Mailing Address - Phone:813-709-8567
Mailing Address - Fax:215-642-8552
Practice Address - Street 1:13021 W LINEBAUGH AVE STE 102
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4509
Practice Address - Country:US
Practice Address - Phone:813-709-8567
Practice Address - Fax:215-642-8552
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102189363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80785OtherBLUE CROSS BLUE SHIELD
FLU7542YMedicare PIN