| Organization Name: | SOUTH LAKE OB/GYN |
| NPI Number: | 1497754121 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MATTHEW STEPHEN CASAVANT (OWNER) |
| Mailing Address: | 1099 Citrus Tower Blvd Ste 120 Clermont |
| State: | FL US |
| Postal Code: | 34711 |
| Phone Number: | 3522417050 |
| Fax Number: | 3522417035 |
| NPI Enumeration Date: | 07/15/2005 |
| NPI Last Update Date: | 01/28/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 07/18/2005 |
| NPI Reactivation Date: | 01/28/2008 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | OS8678 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |