Provider Demographics
NPI:1033158423
Name:SMYK, LEE VLADIMIR (MD PA)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:VLADIMIR
Last Name:SMYK
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:DR
Other - First Name:LADISLAV
Other - Middle Name:VLADIMIR
Other - Last Name:SMYK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:PO BOX 953908
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32795-3908
Mailing Address - Country:US
Mailing Address - Phone:407-328-0825
Mailing Address - Fax:407-322-5478
Practice Address - Street 1:601 E ROLLINS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1248
Practice Address - Country:US
Practice Address - Phone:407-303-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0051452207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046624700Medicaid
FL04676Medicare ID - Type Unspecified
FLE14439Medicare UPIN