Provider Demographics
NPI:1093849747
Name:MICHAEL LAMENSDORF, MD, PA
Entity Type:Organization
Organization Name:MICHAEL LAMENSDORF, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMENSDORF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-957-4987
Mailing Address - Street 1:1428 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2901
Mailing Address - Country:US
Mailing Address - Phone:941-957-4987
Mailing Address - Fax:941-955-7905
Practice Address - Street 1:1428 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2901
Practice Address - Country:US
Practice Address - Phone:941-957-4987
Practice Address - Fax:941-955-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO4520332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1992985261Medicare NSC
FL0555970001Medicare NSC