Unknown Individual – Physician Assistant, NPI 1073577169
Physician Assistant
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
Lake City Post Office, 3019, Northeast 127th Street, Olympic Hills, Lake City, Seattle, King County, Washington, 98165, United States
LAKE CITY, FL 320561642
Phone: (386) 755-1655
Fax: (386) 755-2330
Type: Mailing
Stonegate Terrace, Glencoe, New Trier Township, Cook County, Illinois, 60022, United States
SUITE 103
LAKE CITY, FL 320243457
Phone: (386) 755-1655
Fax: (386) 755-2330
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 32056)
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