Organization
COUNTRYSIDE MEDICAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH BARUCH LEE DO (OWNER PRESIDENT)
(352) 873-4458
Entity
Organization
Contact information
Practice address
7860 SW 103RD STREET RD, BLDG 100 SUITE 101, OCALA, FL 34476-8623
(352) 873-4458
(352) 873-8116
Mailing address
PO BOX 770719, OCALA, FL 34477-0719
(352) 873-4458
(352) 873-8116
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG9421
RR MEDICARE
—
Enumeration date
11/01/2006
Last updated
09/01/2023
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