10D2057427 CLIA NUMBER - LAKE CARDIOVASCULAR DIAGNOSTIC CENTER

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Laboratory Demographics

CLIA Number: 10D2057427

Facility Name: LAKE CARDIOVASCULAR DIAGNOSTIC CENTER

Facility Address:
510 CR 466 STE 105
LADY LAKE, FL
ZIP 32159
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Facility Phone Number: 352 633-7502

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1801135173

Taxonomy: 207RC0000X - Internal Medicine
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

CLIA Record

Field Name	Field Value
CLIA Number	10D2057427
LAB Type	Physician Office
Facility Name	LAKE CARDIOVASCULAR DIAGNOSTIC CENTER
Street	510 CR 466 STE 105
City	LADY LAKE
State	FL
ZIP	32159
Phone	352 633-7502
CertificateType	4
CertificateEffectiveDate	5/4/2024
CertificateExpirationDate	5/3/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024