Healthcare Provider Details

I. General information

NPI: 1265421481
Provider Name (Legal Business Name): LISA A. GOULARTE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA ANN MILLS DO

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 SE 29TH ST #300
TOPEKA KS
66605-2090
US

IV. Provider business mailing address

3310 SE 29TH ST #300
TOPEKA KS
66605-2090
US

V. Phone/Fax

Practice location:
  • Phone: 785-270-7444
  • Fax:
Mailing address:
  • Phone: 785-270-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License Number05-33496
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: