Provider Demographics
NPI:1487712246
Name:LEE COUNTY INTERNAL MEDICINE ASSOCIATES PA
Entity type:Organization
Organization Name:LEE COUNTY INTERNAL MEDICINE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KURAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-573-1606
Mailing Address - Street 1:126 DEL PRADO BLVD N
Mailing Address - Street 2:SUITE104
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-2702
Mailing Address - Country:US
Mailing Address - Phone:239-573-1606
Mailing Address - Fax:239-573-2606
Practice Address - Street 1:126 DEL PRADO BLVD N
Practice Address - Street 2:SUITE104
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2702
Practice Address - Country:US
Practice Address - Phone:239-573-1606
Practice Address - Fax:239-573-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34280OtherBLUE SHIELD
FLCK8842FLMedicare PIN
FL34280Medicare PIN