Organization
NOVU DERMATOLOGY & INTERNAL MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIGDALIA SANES (CREDENTIALING MANAGER)
(352) 427-3882
Entity
Organization
Contact information
Practice address
929 N US HIGHWAY 441 STE 603, LADY LAKE, FL 32159-3003
(407) 216-3888
Mailing address
PO BOX 2420, WINDERMERE, FL 34786-2420
(352) 775-3565
(352) 633-3704
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
10/26/2017
Last updated
10/04/2021
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