| Lakeside Med LLC | |
|
600 N Hiatus Rd Ste 203 Pembroke Pines FL 33026-5207 | |
| (954) 392-7157 | |
| (954) 443-4941 |
| Full Name | Lakeside Med LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 600 N Hiatus Rd Ste 203, Pembroke Pines, Florida |
| Authorized Official Name and Position | Armando Antenor De Feria (PRESIDENT) |
| Authorized Official Contact | 9543927157 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Med LLC 600 N Hiatus Rd Ste 203 Pembroke Pines FL 33026-5207 Ph: (954) 392-7157 | Lakeside Med LLC 600 N Hiatus Rd Ste 203 Pembroke Pines FL 33026-5207 Ph: (954) 392-7157 |
| NPI Number | 1740096049 |
|---|---|
| Provider Enumeration Date | 12/10/2024 |
| Last Update Date | 12/10/2024 |
| Certification Date | 12/10/2024 |
| Medicare PECOS PAC ID | 1254809924 |
|---|---|
| Medicare Enrollment ID | O20260512000210 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740096049 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Secondary |
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Armando a De Feria |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639179807 PECOS PAC ID: 5193896223 Enrollment ID: I20080915000083 |
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