Provider Demographics
NPI:1962497545
Name:LAKE PULMONARY & SLEEP DISORDERS CLINIC P.A.
Entity Type:Organization
Organization Name:LAKE PULMONARY & SLEEP DISORDERS CLINIC P.A.
Other - Org Name:HUMBERTO R. DELGADO MD, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FELIPE
Authorized Official - Middle Name:O
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-728-0709
Mailing Address - Street 1:501 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7324
Mailing Address - Country:US
Mailing Address - Phone:352-728-0709
Mailing Address - Fax:352-728-0709
Practice Address - Street 1:501 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7324
Practice Address - Country:US
Practice Address - Phone:352-728-0709
Practice Address - Fax:352-728-6460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0041828207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253650100Medicaid
FL21618OtherBLUE SHIELD
FL253650100Medicaid