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Organization
LAKE COUNTY PRIMARY MEDICAL CARE LLC
Active
Organization
LAKE COUNTY PRIMARY MEDICAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUJATHA BASKAR MD (OWNER)
(352) 357-0880
Entity
Organization
Contact information
Practice address
33 N CENTER ST, SUITE A, EUSTIS, FL 32726-3580
(352) 357-0880
(352) 357-0334
Mailing address
33 N CENTER ST, SUITE A, EUSTIS, FL 32726-3580
(352) 357-0880
(352) 357-0334
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274014100
—
FL
Enumeration date
10/19/2005
Last updated
12/31/2012
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