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Organization
PALM MEDICAL CENTER LAKELAND LLC
Active
Organization
PALM MEDICAL CENTER LAKELAND LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANTIAGO MOISES MARTIN (PRESIDENT OF CENTER OPERATIONS)
(305) 913-9441
Entity
Organization
Contact information
Practice address
11017 N DALE MABRY HWY STE B, TAMPA, FL 33618-3873
(813) 337-7402
(813) 461-6462
Mailing address
2600 S DOUGLAS RD STE 308, CORAL GABLES, FL 33134-6134
(813) 538-7880
(305) 442-1198
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016289500
—
FL
Enumeration date
07/28/2022
Last updated
07/28/2022
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