Organization
LAKE GASTROENTEROLOGY ASSOCIATES LLC
Active
Organization
LAKE GASTROENTEROLOGY ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOUNDARAPANDIAN BASKAR MD (OWNER/OFFICER)
(352) 636-3652
Entity
Organization
Contact information
Practice address
1703 MAYO DR, TAVARES, FL 32778-4307
(352) 383-5200
(352) 383-3534
Mailing address
PO BOX 1345, MOUNT DORA, FL 32756-1345
(352) 383-5200
(352) 383-3534
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Enumeration date
03/02/2011
Last updated
05/04/2011
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