Provider Demographics
NPI:1831369792
Name:LAKE COUNTY NEUROSURGICALAND SPINAL INSTITUTE
Entity type:Organization
Organization Name:LAKE COUNTY NEUROSURGICALAND SPINAL INSTITUTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-728-3252
Mailing Address - Street 1:704 DOCTORS CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7366
Mailing Address - Country:US
Mailing Address - Phone:352-728-3252
Mailing Address - Fax:352-728-1320
Practice Address - Street 1:704 DOCTORS CT
Practice Address - Street 2:SUITE 101
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7366
Practice Address - Country:US
Practice Address - Phone:352-728-3252
Practice Address - Fax:352-728-1320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68960207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDC0018OtherRAILROAD MEDICARE
FLDC0018OtherRAILROAD MEDICARE
FL27501Medicare PIN