Lake Family Medicine & Imaging

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LAKE FAMILY MEDICINE & IMAGING

Practice address

1403 Medical Plaza Dr Ste 100
Sanford, FL 32771-1085

Phone

(407) 559-5100

Fax

(407) 559-5110

NPI assigned

Dec 17, 2020

Last updated

Dec 17, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Raj Kandavanam

Title

Owner

Phone

(407) 559-5100

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1608163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608163200000",
    "number": "1164018743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1403 MEDICAL PLAZA DR STE 100",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327711085",
            "telephone_number": "407-559-5100",
            "fax_number": "407-559-5110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1403 MEDICAL PLAZA DR STE 100",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327711085",
            "telephone_number": "407-559-5100",
            "fax_number": "407-559-5110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE FAMILY MEDICINE & IMAGING",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-17",
        "last_updated": "2020-12-17",
        "certification_date": "2020-12-17",
        "status": "A",
        "authorized_official_last_name": "KANDAVANAM",
        "authorized_official_first_name": "RAJ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-559-5100"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Sanford, FL
• Providers in Sanford, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.