Organization
SOUTH LAKE OBSTETRICS & GYNECOLOGY, LLC
Active
Other names
SOUTH LAKE OB/GYN AND ADVANCED SURGERY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW STEPHAN CASAVANT DO (OWNER)
(321) 436-8371
Entity
Organization
Contact information
Practice address
1900 DON WICKHAM DR STE 120, CLERMONT, FL 34711-1980
(352) 241-7050
(352) 241-7035
Mailing address
1900 DON WICKHAM DR STE 120, CLERMONT, FL 34711-1980
(352) 241-7050
(352) 241-7035
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
OS8678
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
264093700
—
FL
Enumeration date
07/15/2005
Last updated
03/13/2024
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