Provider Demographics
NPI:1710285796
Name:SAINT CLARES MEDICAL CLINIC
Entity Type:Organization
Organization Name:SAINT CLARES MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LILIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:AKAGBOSU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-937-8991
Mailing Address - Street 1:5131 S FLORIDA AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2514
Mailing Address - Country:US
Mailing Address - Phone:863-937-8991
Mailing Address - Fax:863-937-8992
Practice Address - Street 1:5131 S FLORIDA AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2514
Practice Address - Country:US
Practice Address - Phone:863-937-8991
Practice Address - Fax:863-937-8992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL944162083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty