Individual provider Active NPI

Mikhailia Wanakee Lake, MD

  • Cardiovascular Disease Physician
  • Fort Lauderdale, FL
National Provider Identifier
1639344914
Registry record updated Jul 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
ME 112403 Issued in FL
Practice address
1625 SE 3Rd Ave Ste 620
Fort Lauderdale, FL 33316-2521
Phone
(954) 320-3380
Fax
(954) 320-3371
NPI assigned
Apr 28, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X ME 112403 FL Primary

Addresses

Primary practice location

1625 SE 3Rd Ave Ste 620
Fort Lauderdale, FL 33316-2521

Mailing address

1608 SE 3Rd Ave FL 3
Fort Lauderdale, FL 33316-2564
Phone (954) 320-3380

Other identifiers 1

IdentifierTypeStateIssuer
119118000MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, GA, MT3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20120907000182 FL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 8325296858 Reassigns benefits to 5 organizations
I20240415001108 GA Practitioner - Cardiovascular Disease (Cardiology) 8325296858 Reassigns benefits to 1 organization
I20250328003098 MT Practitioner - Cardiovascular Disease (Cardiology) 8325296858 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Emory University School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Broward Hospital DistrictGroup PAC ID 3577472422, 192 clinicians

Practice addresses (Care Compare)

1 W Sample Rd
Deerfield Beach, FL 33064-3547

1600 S Andrews Ave
Fort Lauderdale, FL 33316-2510

1625 SE 3 Ave
Fort Lauderdale, FL 33316-2521

1625 SE 3Rd Ave
Suite 525
Ft Lauderdale, FL 33316-2521
Phone (954) 355-4975

201 E Sample Rd
Deerfield Beach, FL 33064-3502

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME 112403FLMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Broward Hospital District Current Accepting new patients
Holy Cross Hospital, Inc CurrentSince Jun 16, 2021 Accepting new patients
Lee Health System Inc CurrentSince Oct 1, 2024 Accepting new patients
Lee Memorial Health System CurrentSince Aug 21, 2023 Accepting new patients
Lee Health System Inc CurrentSince Oct 1, 2024 Accepting new patients
Holy Cross Primary Care, Inc CurrentSince Jan 11, 2022 Accepting new patients
Prairie County Hospital District Current Accepting new patients
North Broward Hospital District CurrentSince Jul 14, 2025 Accepting new patients
Holy Cross Hospital Inc Cardiovascular Disease CurrentSince Jun 16, 2021 Accepting new patients
North Broward Hospital District Cardiovascular Disease CurrentSince Jul 14, 2025 Accepting new patients
McCone County Health Center, Inc. Past Accepting new patients

Locations

1138 Country Club Blvd
Cape Coral, FL 33990
Phone (239) 424-1900

708 Del Prado Blvd S
Ste 7
Cape Coral, FL 33990
Phone (239) 424-3660

636 Del Prado Blvd S
Cape Coral, FL 33990
Phone (239) 332-5344

1 W Sample Rd
Ste 208
Deerfield Beach, FL 33064
Phone (954) 946-2570

13681 Doctors Way
Fort Myers, FL 33912
Phone (239) 343-1000

8960 Colonial Center Dr
Ste 302
Fort Myers, FL 33905
Phone (239) 343-9633

9981 S Healthpark Dr
Fort Myers, FL 33908
Phone (239) 332-5344

8931 Colonial Center Dr
Ste 401
Fort Myers, FL 33905
Phone (239) 424-2030

13340 Metro Pkwy
Ste 200
Fort Myers, FL 33966
Phone (239) 343-0550

1569 Matthew Dr
Fort Myers, FL 33907
Phone (941) 939-1700

2776 Cleveland Ave
Fort Myers, FL 33901
Phone (239) 343-2000

4725 N Federal Hwy
#401
Ft Lauderdale, FL 33308
Phone (954) 772-2136

1608 SE 3rd Ave
Fl 3
Ft Lauderdale, FL 33316

1600 S Andrews Ave
Ft Lauderdale, FL 33316
Phone (954) 355-4000

1625 SE 3rd Ave
Ste 620
Ft Lauderdale, FL 33316
Phone (954) 320-3380

1309 S Federal Hwy
#G
Ft Lauderdale, FL 33316
Phone (954) 463-4383

930 S Main St
Ste C
Labelle, FL 33935
Phone (239) 674-5520

1000 NE 56th St
Oakland Park, FL 33334
Phone (954) 229-8608

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: mlake86685@direct.leememorial.org
  • Direct secure messaging: mlake2023536@direct.trinity-health.org

Organizations & group practices 13

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 13

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1209340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753747200000",
    "number": "1639344914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1608 SE 3RD AVE FL 3",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162564",
            "telephone_number": "954-320-3380",
            "fax_number": "954-320-3371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 SE 3RD AVE STE 620",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162521",
            "telephone_number": "954-320-3380",
            "fax_number": "954-320-3371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "MIKHAILIA",
        "middle_name": "WANAKEE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-28",
        "last_updated": "2025-07-29",
        "certification_date": "2025-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "ME 112403",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119118000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

Verify at the official NPI Registry.