Organization
FLORIDA HEART & VASCULAR GROUP, PA
Active
Other names
LEESBURG FAMILY MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
REGINA INGRAM (ADMINISTRATOR)
(352) 728-6808
Entity
Organization
Contact information
Practice address
201 LAGRANDE BLVD, LADY LAKE, FL 32159-1303
(352) 753-0606
Mailing address
201 LAGRANDE BLVD, LADY LAKE, FL 32159-1303
(352) 753-0606
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
Other
Enumeration date
08/08/2008
Last updated
08/08/2008
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