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Organization

LEWIS & KLANCKE CARDIOLOGY PA

Active
Other names
Daytona Heart Group
Organization subpart
No

Provider details

NPI number
Authorized official
KATHY PHILLIPS (CREDENTIALING COORDINATOR)
(386) 258-8722
Entity
Organization

Contact information

Practice address
695 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114
(386) 258-8722
(386) 258-9443
Mailing address
695 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114
(386) 258-8722
(386) 258-8659

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
207RC0001X
Clinical Cardiac Electrophysiology Physician
207RI0011X
Interventional Cardiology Physician
207UN0901X
Nuclear Cardiology Physician
2086S0129X
Vascular Surgery Physician
FL
363L00000X
Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
378998500
FL
01
99279
BC/BS
FL
Enumeration date
08/23/2006
Last updated
09/13/2022
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