Organization
VENEZIA,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICKOLAS SOUMELIDIS MD (FAMILY MEDICINE)
(301) 401-8051
Entity
Organization
Contact information
Practice address
1350 SLEEPY HILL RD, LAKELAND, FL 33810-3800
(863) 858-4402
Mailing address
1625 VILLAGE CENTER DR, APT 203, LAKELAND, FL 33803-2868
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
ME103560
FL
Other
Enumeration date
06/26/2013
Last updated
03/07/2023
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