Organization
LAKE MEDICAL GROUP, LLC
Active
Organization
LAKE MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALFONSO GONZALEZ (PRESIDENT/OWNER)
(305) 801-4030
Entity
Organization
Contact information
Practice address
14750 NW 77TH CT STE 304, MIAMI LAKES, FL 33016-1537
(305) 507-4400
(305) 826-2840
Mailing address
14750 NW 77TH CT STE 304, MIAMI LAKES, FL 33016-1537
(305) 507-4400
(305) 826-2840
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
FL
Other
Enumeration date
03/31/2011
Last updated
08/03/2024
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