Provider Demographics
NPI:1386961894
Name:LAKESIDE OF ORLANDO INC
Entity type:Organization
Organization Name:LAKESIDE OF ORLANDO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATION, ASSISTANT MEDICAL DIR
Authorized Official - Prefix:
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZIK
Authorized Official - Suffix:
Authorized Official - Credentials:
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 1:2314 N ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4803
Practice Address - Country:US
Practice Address - Phone:407-428-9233
Practice Address - Fax:407-428-9667
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKESIDE OCCUPATIONAL MEDICAL CENTERS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME25396261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine