East Lake Medical Clinic
NPI #1790124741 in Saint Cloud, Florida
Provider Information
- NPI Number
- 1790124741
- Entity Type
- Organization
- Organization Name
- East Lake Medical Clinic
- Primary Specialty
- Clinic/Center - Primary Care
- Enumeration Date
- Jun 21, 2013
- Last Updated
- Jun 21, 2013
Practice Location
- Address
- 4737 OLD CANOE CREEK RD
- City
- Saint Cloud
- State
- Florida
- ZIP Code
- 34769-1400
- Phone
- (407) 705-3222
Authorized Official
- Name
- DR. DUSTIN LY, MD
- Title
- PRESIDENT
- Phone
- (407) 705-3222
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Primary Care — Primary Care |
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