NPIMap

Organization Active NPI

Lumen Dermatology LLC

  • Dermatology Physician
  • Lady Lake, FL
National Provider Identifier
1235938341
Registry record updated Jul 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
LUMEN DERMATOLOGY LLC
Practice address
781 Highway 466
Lady Lake, FL 32159-6340
Phone
(352) 830-1500
Fax
(352) 830-1501
NPI assigned
Mar 11, 2025
Last updated
Jul 29, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2026

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

Authorized official

Name
David J Kosiorek, PA-CNPI 1083604144
Title
President
Phone
(813) 598-9837

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

781 Highway 466
Lady Lake, FL 32159-6340

Mailing address

4365 SE 15TH Ave
Ocala, FL 34480-6613
Phone (352) 830-1500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250428002003 FL Part B Supplier - Clinic/Group Practice 6901322544 Receives reassigned benefits from 2 practitioners
Practice locations: Ocala, FL; Lady Lake, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1741651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785283200000",
    "number": "1235938341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4365 SE 15TH AVE",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344806613",
            "telephone_number": "352-830-1500",
            "fax_number": "352-830-1501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "781 HIGHWAY 466",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321596340",
            "telephone_number": "352-830-1500",
            "fax_number": "352-830-1501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUMEN DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-11",
        "last_updated": "2026-07-29",
        "certification_date": "2026-07-29",
        "status": "A",
        "authorized_official_last_name": "KOSIOREK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-598-9837",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lady Lake, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.