Organization
LEWIS & KLANCKE CARDIOLOGY, P.A.
Active
Parent organization
LEWIS & KLANCKE CARADIOLOGY, P.A.
Other names
Daytona Heart Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
LEWIS & KLANCKE CARADIOLOGY, P.A.
Authorized official
KATHLEEN T PHILLIPS (CREDENTIALING COORDINATOR)
(386) 258-8722
Entity
Organization
Contact information
Practice address
780 DUNLAWTON AVE STE 101, PORT ORANGE, FL 32127-4252
(386) 265-5926
(386) 265-5928
Mailing address
695 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2321
(386) 258-8722
(386) 258-9443
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
207UN0901X
Nuclear Cardiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119006900
—
FL
01
—
99279
OTHER
FL
Enumeration date
09/06/2022
Last updated
10/03/2023
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