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Organization
LAKE MEDICAL GROUP, LLC
Active
Organization
LAKE MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALFONSO GONZALEZ (PRESIDENT)
(305) 507-4400
Entity
Organization
Contact information
Practice address
14750 NW 77TH CT STE 304, MIAMI LAKES, FL 33016-1537
(305) 507-4400
(305) 826-2840
Mailing address
14750 NW 77TH CT STE 304, MIAMI LAKES, FL 33016-1537
(305) 507-4400
(305) 826-2840
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
NULL
171M00000X
Case Manager/Care Coordinator
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
—
—
208VP0000X
Pain Medicine Physician
—
NULL
208VP0000X
Pain Medicine Physician
—
—
261QA0600X
Adult Day Care Clinic/Center
—
NULL
261QI0500X
Infusion Therapy Clinic/Center
—
NULL
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
—
NULL
261QX0100X
Occupational Medicine Clinic/Center
—
NULL
291U00000X
Clinical Medical Laboratory
—
NULL
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
—
NULL
Other
Enumeration date
08/03/2024
Last updated
08/03/2024
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