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Organization
LAKELAND PHYSICIANS GROUP LLC
Active
Organization
LAKELAND PHYSICIANS GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN PHILIP NIMBARGI MD (OWNER)
(407) 782-3702
Entity
Organization
Contact information
Practice address
517 BUENA VISTA ST., LAKELAND, FL 33805
(863) 688-3674
(863) 616-9902
Mailing address
PO BOX 150038, ALTAMONTE SPRINGS, FL 32715-0038
(407) 782-3702
(863) 648-9520
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
ME85807
FL
174400000X
Specialist
ME92618
FL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113345
AMERIGROUP
FL
05
—
265742201
—
FL
05
—
275444400
—
FL
01
—
5324701
AETNA
FL
01
—
72117
BCBS
FL
01
—
DG9369
RAILROAD MEDICARE
FL
Enumeration date
06/09/2006
Last updated
12/03/2024
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