Healthcare Provider Details

I. General information

NPI: 1285976290
Provider Name (Legal Business Name): MIRIAM ZYLBERGLAIT LISIGURSKI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 SW 72ND ST STE 502
SOUTH MIAMI FL
33143-4830
US

IV. Provider business mailing address

PO BOX 198054
ATLANTA GA
30384-8054
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-9777
  • Fax: 786-533-9450
Mailing address:
  • Phone: 786-662-7980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License NumberME127719
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME127719
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME127719
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: