Provider Demographics
NPI:1689654766
Name:LAKOMY, DALE G (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:G
Last Name:LAKOMY
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:3663 BEE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233
Practice Address - Country:US
Practice Address - Phone:941-924-8700
Practice Address - Fax:941-924-2320
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME488352085R0203X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP513268OtherOPTIMUM
FL103548OtherAVMED
FLP01257632OtherRAILROAD MCR
FL1989396OtherCIGNA
FL37561OtherBCBS OF FL
FL4018949OtherAETNA
P00355694OtherR.R.MEDICARE
FL268344000Medicaid
FLP102620OtherFREEDOM HEALTH
E08956Medicare UPIN
FL103548OtherAVMED
FL37561OtherBCBS OF FL
FL268344000Medicaid