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Organization
SOUTH LAKE ANESTHESIA SERVICES, P.A.
Active
Organization
SOUTH LAKE ANESTHESIA SERVICES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID S GHIVIZZANI M.D. (OWNER)
(352) 243-9114
Entity
Organization
Contact information
Practice address
1900 DON WICKHAM DR, CLERMONT, FL 34711-1979
(352) 243-9114
(352) 243-7822
Mailing address
PO BOX 100024, ATLANTA, GA 30348-0024
(352) 243-9114
(352) 243-7822
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
259314900
—
FL
01
—
45233
BLUE CROSS BLUE SHIELD
FL
01
—
DA3883
RAILROAD MEDICARE
FL
Enumeration date
07/30/2006
Last updated
12/09/2011
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