Organization
FAMILY PHYSICIANS OF KENDALL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NORMA S LAKE M.D. (OWNER)
(786) 263-0911
Entity
Organization
Contact information
Practice address
11160 SW 88TH ST, SUITE #104 & #105, MIAMI, FL 33176-0949
(786) 263-0911
(786) 263-2761
Mailing address
11160 SW 88TH ST, SUITE #104 & #105, MIAMI, FL 33176-0949
(786) 263-0911
(786) 263-2761
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME 81467
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000141284
ANTHEM BLUE CROSS
OH
01
—
01-03310
UNITED HEALTH CARE
OH
05
—
0151642
—
OH
01
—
0637962
AETNA
OH
01
—
080130460
RAILROAD MEDICARE
OH
Enumeration date
12/27/2007
Last updated
07/02/2008
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