MEDICARE: LISA KAY BRUNDRETT 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	207P00000X	Emergency Medicine Physician	OS8290	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
2	02006	OTHER	FL	BLUECROSS BLUE SHIELD

General Provider Information

NPI Number	:	1942241278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA KAY BRUNDRETT DO

Provider Business Mailing Address
First Line	:	1851 WOOD GLEN CIR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-6329
Country	:	US
Telephone Number	:	561-753-2899
Fax Number	:

Provider Business Practice Location Address
First Line	:	1021 N STATE ROAD 7
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-5117
Country	:	US
Telephone Number	:	561-333-9331
Fax Number	:

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	07/30/2019

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