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

Lake Family Medicine & Imaging

Organization Family Medicine Physician · NPI 1164018743

Lake Family Medicine & Imaging is a Family Medicine Physician in Sanford, Florida. Registered with an NPI since 2020.

In the registry since
2020

Practice location Address checks out

1403 Medical Plaza Dr Ste 100
Sanford, FL 32771-1085
Phone: (407) 559-5100
Fax: (407) 559-5110
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X

Record details

NPI number1164018743
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Raj Kandavanam — Owner · (407) 559-5100
NPI enumeratedDecember 17, 2020
Last updated in NPPESDecember 17, 2020
Certification dateDecember 17, 2020
Mailing address1403 Medical Plaza Dr Ste 100, Sanford, FL 32771-1085

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