LAKE CANCER & HEMATOLOGY PA
Medical Practice at 3 St, Leesburg, FL

License number
Florida ME24875
Category
Medical Practice
Type
Specialist
Owner
Name: DR. LOURDES M MATHEW MD
Title: OWNER
Phone: (352) 728-2532
Address
Address
732 N 3Rd St, Leesburg, FL 34748
National Provider ID: 1366855967
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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LAKE CANCER & HEMATOLOGY, PA

732 N 3 St, Leesburg, FL 34748

Registration:
Jun 9, 2014
State ID:
P14000049573
Business type:
Florida Profit Corporation
Director:
Lourdes M Mathew (Director), 732 N 3 St, Leesburg, FL 34748 (Physical)
Agent:
Lourdes Mathew,732 N 3 St, Leesburg, FL 34748 (Physical)
EIN:
47-1063257

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