| Liveactive Multispecialty Physician Group Tampa Llc | |
|
1201 Oakbridge Pkwy Lakeland FL 33803-5945 | |
| (913) 549-3884 | |
| Not Available |
| Full Name | Liveactive Multispecialty Physician Group Tampa Llc |
|---|---|
| Speciality | Hospitalist |
| Location | 1201 Oakbridge Pkwy, Lakeland, Florida |
| Authorized Official Name and Position | Shane Brethowr (CEO/AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 9135493884 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Liveactive Multispecialty Physician Group Tampa Llc 7111 W 151st St Ste 303 Overland Park KS 66223-2231 Ph: () - | Liveactive Multispecialty Physician Group Tampa Llc 1201 Oakbridge Pkwy Lakeland FL 33803-5945 Ph: (913) 549-3884 |
| NPI Number | 1891556049 |
|---|---|
| Provider Enumeration Date | 01/16/2024 |
| Last Update Date | 02/04/2024 |
| Medicare PECOS PAC ID | 7416390158 |
|---|---|
| Medicare Enrollment ID | O20240208004443 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891556049 | NPI | - | NPPES |
| Provider Name | Haseeb Ahmed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972701571 PECOS PAC ID: 4587788013 Enrollment ID: I20240208004470 |
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