Healthcare Provider Details

I. General information

NPI: 1164539011
Provider Name (Legal Business Name): LISE M LAMBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 BAYVIEW DR
FT LAUDERDALE FL
33304-2505
US

IV. Provider business mailing address

1124 BAYVIEW DR
FT LAUDERDALE FL
33304-2505
US

V. Phone/Fax

Practice location:
  • Phone: 954-567-1006
  • Fax: 954-566-9270
Mailing address:
  • Phone: 954-567-1006
  • Fax: 954-566-9270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME40766
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: