Provider Demographics
NPI:1053722009
Name:DEDEA, LAUREN MICHELE (MD)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MICHELE
Last Name:DEDEA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5100
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34611-5100
Mailing Address - Country:US
Mailing Address - Phone:352-610-4812
Mailing Address - Fax:352-556-4980
Practice Address - Street 1:4052 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-2398
Practice Address - Country:US
Practice Address - Phone:352-610-4812
Practice Address - Fax:352-556-4980
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME137363207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101025300Medicaid
FLPHUU1OtherBCBS