Favilli, Luis Clyde
Favilli, Luis Clyde is an sole proprietor health care provider with primary practice located at 3650 Innovation Dr , Lakeland FL 33812-4105. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Favilli, Luis Clyde can be contacted via phone (860) 709-1968.Contact Information
Primary practice address
3650 Innovation Dr
Lakeland FL 33812-4105
Phone: (860) 709-1968
Fax: (863) 701-2151
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | ME56610 | Florida |
Profile Details
| NPI number | 1013912625 |
|---|---|
| LBN Legal business name | Favilli, Luis Clyde |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 20th, 2005 |
| Last updated | May 30th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1013912625 | NPPES |
| Florida | MEDICAID | 374563500 |
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