Provider Demographics
NPI:1760484745
Name:LAKELAND FAMILY MEDICINE
Entity Type:Organization
Organization Name:LAKELAND FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RIFAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SARWAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-687-9333
Mailing Address - Street 1:1305 LAKELAND HILLS BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-4542
Mailing Address - Country:US
Mailing Address - Phone:863-687-9333
Mailing Address - Fax:863-686-0160
Practice Address - Street 1:1305 LAKELAND HILLS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4542
Practice Address - Country:US
Practice Address - Phone:863-687-9333
Practice Address - Fax:863-686-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048897261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF72392Medicare UPIN
FL23668Medicare ID - Type Unspecified