Provider Demographics
NPI:1659716975
Name:LEE COUNTY PHYSICAL MEDICINE LLC
Entity Type:Organization
Organization Name:LEE COUNTY PHYSICAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAMPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-245-7909
Mailing Address - Street 1:6150 DIAMOND CENTRE CT
Mailing Address - Street 2:SUITE 1003
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4368
Mailing Address - Country:US
Mailing Address - Phone:239-245-7909
Mailing Address - Fax:239-245-7981
Practice Address - Street 1:6150 DIAMOND CENTRE CT
Practice Address - Street 2:SUITE 1003
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4368
Practice Address - Country:US
Practice Address - Phone:239-245-7909
Practice Address - Fax:239-245-7981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
FLME100125207R00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty