Provider Demographics
NPI:1396807640
Name:LAKE HOSPITALIST INC
Entity type:Organization
Organization Name:LAKE HOSPITALIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-728-5466
Mailing Address - Street 1:1032 SHORE ACRES DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-4506
Mailing Address - Country:US
Mailing Address - Phone:352-728-5466
Mailing Address - Fax:
Practice Address - Street 1:600 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5925
Practice Address - Country:US
Practice Address - Phone:352-323-5762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62802XMedicare ID - Type Unspecified
FLH76455Medicare UPIN