Provider Demographics
NPI:1346492030
Name:CLIFFORD A LAKIN MD P A
Entity Type:Organization
Organization Name:CLIFFORD A LAKIN MD P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-491-1095
Mailing Address - Street 1:4640 N FEDERAL HWY STE D
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5205
Mailing Address - Country:US
Mailing Address - Phone:954-491-1095
Mailing Address - Fax:954-491-1097
Practice Address - Street 1:4640 N FEDERAL HWY STE D
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5205
Practice Address - Country:US
Practice Address - Phone:954-491-1095
Practice Address - Fax:954-491-1097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME16123208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0594521-00Medicaid
FLD60485Medicare UPIN