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Organization
LAKE FOOT CLINIC INC
Active
Organization
LAKE FOOT CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES T ROTELLA DPM (PRESIDENT OWNER OF LAKE FOOT CLINIC)
(352) 589-1335
Entity
Organization
Contact information
Practice address
629 S GROVE ST, EUSTIS, FL 32726
(352) 589-1335
(352) 589-1336
Mailing address
629 S GROVE ST, EUSTIS, FL 32726
(352) 589-1335
(352) 589-1336
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PO1193
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K8096
MEDICARE GROUP NUMBER
FL
Enumeration date
02/29/2008
Last updated
11/12/2008
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