Provider Demographics
NPI:1326276445
Name:LAMA, MAXIMO (MD)
Entity Type:Individual
Prefix:
First Name:MAXIMO
Middle Name:
Last Name:LAMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 POLYNESIAN ISLE BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-1818
Mailing Address - Country:US
Mailing Address - Phone:407-507-2615
Mailing Address - Fax:407-507-2616
Practice Address - Street 1:3480 POLYNESIAN ISLE BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746
Practice Address - Country:US
Practice Address - Phone:407-507-2615
Practice Address - Fax:407-507-2616
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109403207RC0200X
FLME 109403207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00-3705600Medicaid
FLFH071YMedicare PIN