Individual provider · NPI-1

Dr. Mark Edward Lamielle, DO

Family Medicine · Ruskin, FL

NPI number1609877752
StatusActive
Last updated in NPPESJun 8, 2021

Details

NPI
1609877752
Entity type
Individual (NPI-1)
Name
Dr. Mark Edward Lamielle
Credential
DO
Sex
Male
Sole proprietor
No
Enumeration date
Aug 10, 2005
Certification date
Jun 8, 2021
Last updated
Jun 8, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family MedicineOS12113FLYes
207Q00000X Family Medicine34-00-4531OH

Practice location

787 Cortaro Dr
Ruskin, FL 33573-6812

Phone 813-634-2500 · Fax 813-634-3008

Mailing address

10051 5th Street North
Suite 200
St. Petersburg, FL 33702-2211

Phone 727-828-2370 · Fax 727-568-6011

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