Provider Demographics
NPI:1518922947
Name:LAKEWOOD RANCH PRIMARY CARE LLC
Entity Type:Organization
Organization Name:LAKEWOOD RANCH PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MISHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-907-0588
Mailing Address - Street 1:8340 LAKEWOOD RANCH BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5180
Mailing Address - Country:US
Mailing Address - Phone:941-907-0588
Mailing Address - Fax:941-373-6622
Practice Address - Street 1:8340 LAKEWOOD RANCH BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5180
Practice Address - Country:US
Practice Address - Phone:941-907-0588
Practice Address - Fax:941-373-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34586OtherBCBS
FLDA1812OtherMCR RR
FLDA1812OtherMCR RR
FLDA1812OtherMCR RR