Organization
LAKESIDE SURGERY LTD
Active
Other names
Lakeside Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARGIE A BRILL (ADMINISTRATOR)
(407) 206-2375
Entity
Organization
Contact information
Practice address
1825 N MILLS AVE, ORLANDO, FL 32803
(407) 206-2375
(407) 206-2377
Mailing address
1825 N MILLS AVE, ORLANDO, FL 32803
(407) 206-2375
(407) 206-2377
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
288415
WELLCARE
FL
01
—
97107
BCBS
FL
Enumeration date
05/23/2006
Last updated
05/20/2008
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