Organization
MULTI-SPECIALTY & PRIMARY CARE PRACTICE GROUP OF LAKE WALES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KOLLAGUNTA S CHANDRASEKHAR M.D. (OWNER)
(863) 294-5505
Entity
Organization
Contact information
Practice address
1255 STATE ROAD 60 EAST, LAKE WALES, FL 33853
(863) 232-5111
(866) 922-0875
Mailing address
1255 STATE ROAD 60 EAST, LAKE WALES, FL 33853
(863) 232-5111
(866) 922-0875
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
10/31/2008
Last updated
04/08/2009
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