Provider Demographics
NPI:1083742274
Name:DRS FRIEDENSTAB & LUM PA
Entity Type:Organization
Organization Name:DRS FRIEDENSTAB & LUM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-562-6566
Mailing Address - Street 1:777 37TH ST STE C101
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7301
Mailing Address - Country:US
Mailing Address - Phone:772-562-6566
Mailing Address - Fax:772-562-6570
Practice Address - Street 1:777 37TH ST STE C101
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7301
Practice Address - Country:US
Practice Address - Phone:772-562-6566
Practice Address - Fax:772-562-6570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME004400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD57488Medicare UPIN
FL62613XMedicare ID - Type UnspecifiedA. FRIEDENSTAB
FL62534XMedicare ID - Type UnspecifiedK. LUM
FLD57516Medicare UPIN
FLK0449Medicare ID - Type UnspecifiedMCR GROUP NUMBER