Provider Demographics
NPI:1538592324
Name:LAKEWOOD RANCH HOSPITALISTS INC
Entity type:Organization
Organization Name:LAKEWOOD RANCH HOSPITALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEJMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-542-5420
Mailing Address - Street 1:11160 LOST CREEK TER
Mailing Address - Street 2:APT #301
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-9357
Mailing Address - Country:US
Mailing Address - Phone:404-542-5420
Mailing Address - Fax:
Practice Address - Street 1:6400 EDGELAKE DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-8813
Practice Address - Country:US
Practice Address - Phone:404-542-5420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113400208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty