Provider Demographics
NPI:1225069735
Name:LAKELAND PHYSICIANS GROUP
Entity Type:Organization
Organization Name:LAKELAND PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:NIMBARGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-782-3702
Mailing Address - Street 1:5450 SANDY RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771
Mailing Address - Country:US
Mailing Address - Phone:407-782-3702
Mailing Address - Fax:407-268-9664
Practice Address - Street 1:3234 S FLORIDA AVE
Practice Address - Street 2:STE F
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803
Practice Address - Country:US
Practice Address - Phone:863-648-4275
Practice Address - Fax:863-648-9520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty