Organization
LAKE SHORE CENTER FOR AESTHETICS & PLASTIC SURGERY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELINDA KEENER MD (PRESIDENT)
(386) 755-6676
Entity
Organization
Contact information
Practice address
263 SW PROFESSIONAL GLN, LAKE CITY, FL 32025-1105
(386) 755-6676
(386) 755-1667
Mailing address
263 SW PROFESSIONAL GLN, LAKE CITY, FL 32025-1105
(386) 755-6676
(386) 755-1667
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
ME 105501
FL
Other
Enumeration date
11/04/2013
Last updated
01/07/2014
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