Provider Demographics
NPI:1144517202
Name:LAKESIDE OF LAKELAND INC
Entity type:Organization
Organization Name:LAKESIDE OF LAKELAND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZIK
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:727-532-7644
Mailing Address - Street 1:7527 ULMERTON RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-4548
Mailing Address - Country:US
Mailing Address - Phone:727-586-0138
Mailing Address - Fax:727-586-6954
Practice Address - Street 1:7527 ULMERTON RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-4548
Practice Address - Country:US
Practice Address - Phone:727-586-0138
Practice Address - Fax:727-586-6954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 25396261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine