Organization
LEWIS & KLANCKE CARDIOLOGY PA
Active
Parent organization
LEWIS & KLANCKE CARDIOLOGY PA
Other names
Daytona Heart Group, Daytona Heart Group Orange City
Organization subpart
Yes
Provider details
NPI number
Legal business name
LEWIS & KLANCKE CARDIOLOGY PA
Authorized official
MS. KATHLEEN T PHILLIPS (CREDENTIALING COORDINATOR)
(386) 258-8722
Entity
Organization
Contact information
Practice address
938 SAXON BLVD, SUITE 101-C, ORANGE CITY, FL 32763-8305
(386) 774-5485
(386) 775-0761
Mailing address
695 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2321
(386) 258-8722
(386) 258-8659
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RI0011X
Interventional Cardiology Physician
—
—
207UN0901X
Nuclear Cardiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
378998500
—
FL
Enumeration date
02/20/2007
Last updated
09/07/2022
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