Provider Demographics
NPI:1801135173
Name:LAKE CARDIOVASCULAR DIAGNOSTIC CENTER L.L.C
Entity type:Organization
Organization Name:LAKE CARDIOVASCULAR DIAGNOSTIC CENTER L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHRIKANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:UPADYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-633-1966
Mailing Address - Street 1:1050 OLD CAMP RD
Mailing Address - Street 2:STE 270
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-1762
Mailing Address - Country:US
Mailing Address - Phone:352-633-1966
Mailing Address - Fax:
Practice Address - Street 1:510 HIGHWAY 466
Practice Address - Street 2:SUITE 105
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-6341
Practice Address - Country:US
Practice Address - Phone:352-633-1966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARDIAC AND VASCULAR CONSULTANTS P.A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-06
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty