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LAKESIDE DERMATOLOGY LLC NPI 1922257260


NPI Information

NPI: 1922257260
Provider Name: LAKESIDE DERMATOLOGY LLC
Classification: Dermatology - 207N00000X
Entity Type: Organization

CLIA Number: 10D2152321

Address:
727 US 27 S
SEBRING, FL
ZIP 33870
Phone: (863) 385-7183
Get Directions

LAKESIDE DERMATOLOGY LLC is a dermatology in Sebring, FL. The provider is a dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. LAKESIDE DERMATOLOGY LLC NPI is 1922257260. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

727 US 27 S
SEBRING, FL
ZIP 33870-169
Phone: (863) 385-7183
Fax: (863) 385-0088

The provider's authorized official is Michael Joseph Rogers .
The authorized official title is Sole Mbr and has the following contact phone number (863) 385-7183.

The CLIA number assigned to this NPI record is 10D2152321 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 9/11/2008 and was last updated on 9/11/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207NS0135XDermatologyProcedural DermatologyME0058778FLORIDANo
2207N00000XDermatologyME0058778FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1E59551MEDICARE UPINFLORIDA
2K7022MEDICARE PINFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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