Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

East Lake Medical Clinic

Organization Primary Care Clinic/Center · NPI 1790124741

East Lake Medical Clinic is a Primary Care Clinic/Center in Saint Cloud, Florida. Licensed in Florida. Registered with an NPI since 2013.

Licensed in
FL
In the registry since
2013

Practice location Address checks out

4737 Old Canoe Creek Rd
Saint Cloud, FL 34769-1400
Phone: (407) 705-3222
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Primary Care Clinic/Center (primary) Taxonomy 261QP2300X · Licence ME114777 (FL)

Record details

NPI number1790124741
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Dustin Ly — President · (407) 705-3222
NPI enumeratedJune 21, 2013
Last updated in NPPESJune 21, 2013
Mailing address4737 Old Canoe Creek Rd, Saint Cloud, FL 34769-1400

Other providers in Saint Cloud