| Sunlake Medical Associates | |
|
18964 Dale Mabry Hwy N Ste 101 Lutz FL 33548-4913 | |
| (813) 948-2107 | |
| (813) 948-2790 |
| Full Name | Sunlake Medical Associates |
|---|---|
| Speciality | Clinic/Center |
| Location | 18964 Dale Mabry Hwy N, Lutz, Florida |
| Authorized Official Name and Position | Luis A. Logrono (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8139482107 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sunlake Medical Associates 18964 Dale Mabry Hwy N Ste 101 Lutz FL 33548-4913 Ph: (813) 948-2107 | Sunlake Medical Associates 18964 Dale Mabry Hwy N Ste 101 Lutz FL 33548-4913 Ph: (813) 948-2107 |
| NPI Number | 1114153483 |
|---|---|
| Provider Enumeration Date | 06/01/2009 |
| Last Update Date | 04/01/2010 |
| Medicare PECOS PAC ID | 9133269756 |
|---|---|
| Medicare Enrollment ID | O20091211000660 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114153483 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | HCC8458 (Florida) | Primary |
| Provider Name | Luis A Logrono |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700875739 PECOS PAC ID: 9739148602 Enrollment ID: I20041006000862 |
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