Organization
LEWIS & KLANCKE CARDIOLOGY PA
Active
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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