Provider Demographics
NPI:1952585796
Name:FAMILY PHYSICIANS OF KENDALL LLC
Entity Type:Organization
Organization Name:FAMILY PHYSICIANS OF KENDALL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-263-0911
Mailing Address - Street 1:11160 SW 88TH ST
Mailing Address - Street 2:SUITE #104 & #105
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-0949
Mailing Address - Country:US
Mailing Address - Phone:786-263-0911
Mailing Address - Fax:786-263-2761
Practice Address - Street 1:11160 SW 88TH ST
Practice Address - Street 2:SUITE #104 & #105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-0949
Practice Address - Country:US
Practice Address - Phone:786-263-0911
Practice Address - Fax:786-263-2761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 81467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0637962OtherAETNA
OH080130460OtherRAILROAD MEDICARE
OH01-03310OtherUNITED HEALTH CARE
OH0151642Medicaid
OH000000141284OtherANTHEM BLUE CROSS
OH01-03310OtherUNITED HEALTH CARE
OH0637962OtherAETNA