Basic Information
| Provider Information | |||||||||
| NPI: | 1932198215 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LENZ | ||||||||
| FirstName: | FEDERICO | ||||||||
| MiddleName: | ELENA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 PINELLAS ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337563354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274451911 | ||||||||
| FaxNumber: | 7274451986 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 PINELLAS ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337563354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274451911 | ||||||||
| FaxNumber: | 7274451986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2005 | ||||||||
| LastUpdateDate: | 10/05/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | ME34667 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | ME34666 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 038246900 | 05 | FL | MEDICAID |