MEDICARE: LISA A. GOULARTE DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VB0002X	Obesity Medicine (Obstetrics & Gynecology) Physician	05-33496	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265421481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA A. GOULARTE DO

Provider Business Mailing Address
First Line	:	3310 SE 29TH ST
Second Line	:	#300
City	:	TOPEKA
State	:	KS
Zip	:	66605-2090
Country	:	US
Telephone Number	:	785-270-7444
Fax Number	:

Provider Business Practice Location Address
First Line	:	3310 SE 29TH ST
Second Line	:	#300
City	:	TOPEKA
State	:	KS
Zip	:	66605-2090
Country	:	US
Telephone Number	:	785-270-7444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	05/24/2023

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