Organization
PALM MEDICAL CENTER LAKELAND LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANTIAGO MOISES MARTIN (PRESIDENT OF CENTER OPERATIONS)
(305) 913-9441
Entity
Organization
Contact information
Practice address
11017 N DALE MABRY HWY STE B, TAMPA, FL 33618-3873
(813) 337-7402
(813) 461-6462
Mailing address
2600 S DOUGLAS RD STE 308, CORAL GABLES, FL 33134-6134
(813) 538-7880
(305) 442-1198
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016289500
—
FL
Enumeration date
07/28/2022
Last updated
07/28/2022
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