Provider Demographics
NPI:1770727646
Name:LAKELAND FAMILY MEDICINE
Entity type:Organization
Organization Name:LAKELAND FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
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:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805
Mailing Address - Country:US
Mailing Address - Phone:863-687-9333
Mailing Address - Fax:
Practice Address - Street 1:1305 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33806
Practice Address - Country:US
Practice Address - Phone:863-687-9333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL593454137305R00000X
FLME0048897261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No305R00000XManaged Care OrganizationsPreferred Provider Organization