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Organization

INTERNAL MEDICINE OF LAKE CITY PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. SHAMMI K BALI MD (PRESIDENT)
(386) 755-1703
Entity
Organization

Contact information

Practice address
289 SW STONEGATE TER, SUITE 104, LAKE CITY, FL 32024-3456
(386) 755-1703
(386) 755-1744
Mailing address
289 SW STONEGATE TER, SUITE 104, LAKE CITY, FL 32024-3456
(386) 755-1703
(386) 755-1744

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
BB6375477
FL

Other

Enumeration date
10/09/2007
Last updated
09/30/2013
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