Provider Demographics
NPI:1881477412
Name:LAKEWOOD RANCH ENTERPRISES LLC
Entity type:Organization
Organization Name:LAKEWOOD RANCH ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BORSHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-944-9365
Mailing Address - Street 1:11161 E STATE ROAD 70
Mailing Address - Street 2:SUITE #110, PMB#166
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202
Mailing Address - Country:US
Mailing Address - Phone:941-289-1110
Mailing Address - Fax:941-289-2492
Practice Address - Street 1:8330 LAKEWOOD RANCH BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5174
Practice Address - Country:US
Practice Address - Phone:941-289-1110
Practice Address - Fax:941-289-2492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty