Organization
SOUTH LAKE GASTROENTEROLOGY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAMESH RAMPERSAD (ADMINISTRATOR)
(352) 242-1665
Entity
Organization
Contact information
Practice address
2040 OAKLEY SEAVER DR, CLERMONT, FL 34711-1962
(352) 242-1665
(352) 243-1649
Mailing address
PO BOX 120930, CLERMONT, FL 34712-0930
(352) 242-1665
(352) 243-1649
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME74082
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
256031300
—
FL
01
—
43437
FL BCBS
FL
01
—
5858631
AETNA
FL
01
—
E0302Z
MEDICARE INDIVIDUAL
FL
Enumeration date
09/11/2007
Last updated
07/18/2014
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