Provider Demographics
NPI:1932198215
Name:LENZ, FEDERICO ELENA (MD)
Entity Type:Individual
Prefix:
First Name:FEDERICO
Middle Name:ELENA
Last Name:LENZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 PINELLAS ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3354
Mailing Address - Country:US
Mailing Address - Phone:727-445-1911
Mailing Address - Fax:727-445-1986
Practice Address - Street 1:455 PINELLAS ST
Practice Address - Street 2:SUITE 400
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3354
Practice Address - Country:US
Practice Address - Phone:727-445-1911
Practice Address - Fax:727-445-1986
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34667207RC0000X
FLME34666207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038246900Medicaid
FL038246900Medicaid
D57335Medicare UPIN