Organization
EAST LAKE MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DUSTIN LY MD (PRESIDENT)
(407) 705-3222
Entity
Organization
Contact information
Practice address
4737 OLD CANOE CREEK RD, SAINT CLOUD, FL 34769-1400
(407) 705-3222
Mailing address
4737 OLD CANOE CREEK RD, SAINT CLOUD, FL 34769-1400
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
ME114777
FL
Other
Enumeration date
06/21/2013
Last updated
06/21/2013
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