# VASCULAR SPECIALISTS OF LAKELAND, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548526155
- **Authorized official:** EDWARD J GOODEMOTE PHD, RN (CEO)
- **Authorized official phone:** (863) 688-2334

## Contact information

- **Practice address:** 2125 CRYSTAL GROVE DR, LAKELAND, FL 33801-6875
- **Practice address phone:** (863) 688-2334
- **Practice address fax:** (863) 577-1167
- **Mailing address:** 2125 CRYSTAL GROVE DR, LAKELAND, FL 33801-6875
- **Mailing address phone:** (863) 688-2334
- **Mailing address fax:** (863) 577-1167

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/09/2012
- **Last updated:** 08/12/2013