Organization
LUMEN DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID J KOSIOREK PA-C (PRESIDENT)
(813) 598-9837
Entity
Organization
Contact information
Practice address
781 HIGHWAY 466, LADY LAKE, FL 32159-6340
(352) 830-1500
Mailing address
4365 SE 15TH AVE, OCALA, FL 34480-6613
(352) 598-5763
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
03/11/2025
Last updated
03/16/2025
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