Healthcare Provider Details

I. General information

NPI: 1952365405
Provider Name (Legal Business Name): LISA CARDWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27209 LAHSER #220
SOUTHFIELD MI
48034
US

IV. Provider business mailing address

27209 LAHSER #220
SOUTHFIELD MI
48034
US

V. Phone/Fax

Practice location:
  • Phone: 248-603-4240
  • Fax: 248-603-4249
Mailing address:
  • Phone: 248-603-4240
  • Fax: 248-603-4249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberLC060034
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: