# SOUTH LAKE OBSTETRICS & GYNECOLOGY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SOUTH LAKE OB/GYN AND ADVANCED SURGERY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497754121
- **Authorized official:** MR. MATTHEW STEPHAN CASAVANT DO (OWNER)
- **Authorized official phone:** (321) 436-8371

## Contact information

- **Practice address:** 1900 DON WICKHAM DR STE 120, CLERMONT, FL 34711-1980
- **Practice address phone:** (352) 241-7050
- **Practice address fax:** (352) 241-7035
- **Mailing address:** 1900 DON WICKHAM DR STE 120, CLERMONT, FL 34711-1980
- **Mailing address phone:** (352) 241-7050
- **Mailing address fax:** (352) 241-7035

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | OS8678 | FL | Yes |

## Other

- **Enumeration date:** 07/15/2005
- **Last updated:** 03/13/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 264093700 | — | FL |