Provider Demographics
NPI:1740697622
Name:LUGO ROSADO, LUIS DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS DANIEL
Middle Name:
Last Name:LUGO ROSADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LUIS DANIEL
Other - Middle Name:
Other - Last Name:LUGO ROSADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1324 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-4543
Mailing Address - Country:US
Mailing Address - Phone:863-687-1100
Mailing Address - Fax:863-630-6528
Practice Address - Street 1:1324 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4543
Practice Address - Country:US
Practice Address - Phone:863-687-1321
Practice Address - Fax:863-603-6534
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-12
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01078605A207R00000X
NY291213207R00000X, 208M00000X
FLME146551207R00000X
RILP03194207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist