| R. R.lastomirsky, M.d., P.a. | |
|
740 The Rialto Venice FL 34285-3524 | |
| (941) 484-8414 | |
| (941) 488-7586 |
| Full Name | R. R.lastomirsky, M.d., P.a. |
|---|---|
| Speciality | Internal Medicine |
| Location | 740 The Rialto, Venice, Florida |
| Authorized Official Name and Position | Robert Raymond Lastomirsky (OWNER/OPERATOR) |
| Authorized Official Contact | 9414848414 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| R. R.lastomirsky, M.d., P.a. 740 The Rialto P. O. Box 1803 Venice FL 34285-3524 Ph: (941) 484-8414 | R. R.lastomirsky, M.d., P.a. 740 The Rialto Venice FL 34285-3524 Ph: (941) 484-8414 |
| NPI Number | 1487759809 |
|---|---|
| Provider Enumeration Date | 09/13/2006 |
| Last Update Date | 12/04/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487759809 | NPI | - | NPPES |
| 1306860382 | Other | FL | NPI PHYSICIAN NUMBER |
| ME0032829 | Other | FL | STATE LISCENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME0032829 (Florida) | Primary |
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