LAKE SURGICAL CLINIC PA
Medical Practice at Dixie Ave, Leesburg, FL

License number
Florida ME16817
Category
Medical Practice
Type
Specialist
Owner
Name: DR. DAVID W BURNSED M.D.
Title: OWNER
Phone: (352) 787-8230
Address
Address
1111 W Dixie Ave, Leesburg, FL 34748
National Provider ID: 1114105442
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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LAKE SURGICAL CLINIC, PA

Leesburg, FL

Status:
Inactive
Doing business as:
Lake Surgical Clinic
Inactive reason:
ADMIN DISSOLUTION FOR ANNUAL REPORT
Registration:
Jul 1, 1977
Inactive since:
Sep 27, 2013
Phone:
(352) 787-8230 (Phone)
Addresses:
9585 Silver Lk Dr, Leesburg, FL 34788 (Physical)
1111 W Dixie Ave, Leesburg, FL 34748
1111 W Dixie Ave Lrmc Plz, Leesburg, FL 34748
State ID:
538141
Business type:
Florida Profit Corporation
President, Treasurer, Directors:
Burnsed, David W., M.d, 9585 Silver Lk Dr, Leesburg, FL 34788 (Physical),David W. Burnsed President, Treasurer, Director, inactive
EIN:
59-1753397

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