NPIMap

Organization Active NPI

Restoration Medicine LLC

  • Gynecology Physician
  • Merritt Island, FL
National Provider Identifier
1386975415
Registry record updated Apr 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
ME92412 Issued in FL
Legal business name
RESTORATION MEDICINE LLC
Practice address
190 S Sykes Creek Pkwy
Suite #3
Merritt Island, FL 32952-3572
Phone
(321) 305-6254
Fax
(321) 305-5972
NPI assigned
Jan 29, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2011

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

Authorized official

Name
Dr. Lance Andre Maki, M.D.
Title
President
Phone
(321) 305-6254

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VG0400X ME92412 FL Primary

Addresses

Primary practice location

190 S Sykes Creek Pkwy
Suite #3
Merritt Island, FL 32952-3572

Mailing address

190 S Sykes Creek Pkwy
Suite #3
Merritt Island, FL 32952-3572
Phone (321) 305-6254

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1264723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302480000000",
    "number": "1386975415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 S SYKES CREEK PKWY",
            "address_2": "SUITE #3",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329523572",
            "telephone_number": "321-305-6254",
            "fax_number": "321-305-5972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 S SYKES CREEK PKWY",
            "address_2": "SUITE #3",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329523572",
            "telephone_number": "321-305-6254",
            "fax_number": "321-305-5972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORATION MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-29",
        "last_updated": "2011-04-11",
        "status": "A",
        "authorized_official_last_name": "MAKI",
        "authorized_official_first_name": "LANCE",
        "authorized_official_middle_name": "ANDRE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-305-6254",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "FL",
            "license": "ME92412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Merritt Island, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2011; 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.