MEDICARE: LISA PEREZ-GROSSMAN, M.D., P.A.

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	208000000X	Pediatrics Physician	ME0071327	FL

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	:	1487835922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA PEREZ-GROSSMAN, M.D., P.A.

Provider Business Mailing Address
First Line	:	1235 SW 87TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33174-3306
Country	:	US
Telephone Number	:	305-269-1990
Fax Number	:	305-269-1970

Provider Business Practice Location Address
First Line	:	1235 SW 87TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33174-3306
Country	:	US
Telephone Number	:	305-269-1990
Fax Number	:	305-269-1970

Authorized Official
Title or Position	:	DR.
Name	:	DR. LISA MARIA PEREZ-GROSSMAN
Credential	:	M.D.
Telephone Number	:	305-269-1990

Provider Enumeration Date	:	11/26/2007
Last Update Date	:	10/11/2016

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