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NPI Code Detail

MEDICARE: DR. LISA MICHELLE WEDDERBURN DPM

MEDICARE: DR. LISA MICHELLE WEDDERBURN DPM
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
1213E00000XPodiatristN005519NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659398493
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA MICHELLE WEDDERBURN DPM
Provider Business Mailing Address
First Line : 722 E 51ST ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-5902
Country : US
Telephone Number : 917-991-1279
Fax Number : 877-868-8633
Provider Business Practice Location Address
First Line : 2146 BEVERLEY RD
Second Line :
City : BROOKLYN
State : NY
Zip : 11226-5406
Country : US
Telephone Number : 718-210-3296
Fax Number : 877-868-8633
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 10/01/2008

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