Provider Demographics
NPI:1497713390
Name:LAKE HOWELL FAMILY MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:LAKE HOWELL FAMILY MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SILVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-677-4867
Mailing Address - Street 1:590 RUBY CT
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5226
Mailing Address - Country:US
Mailing Address - Phone:407-677-4867
Mailing Address - Fax:407-677-4203
Practice Address - Street 1:590 RUBY CT
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5226
Practice Address - Country:US
Practice Address - Phone:407-677-4867
Practice Address - Fax:407-677-4203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0003966207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373802700Medicaid
FL33370OtherBCBS
FL373802700Medicaid