Healthcare Provider Details

I. General information

NPI: 1205857729
Provider Name (Legal Business Name): LISA CAROLE TURNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA CAROLE VERNO M.D.

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 MCAULEY DR
YPSILANTI MI
48197-1051
US

IV. Provider business mailing address

5912 DUNMORE DR
WEST BLOOMFIELD MI
48322-1616
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-3325
  • Fax: 734-712-5525
Mailing address:
  • Phone: 248-865-2645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301071720
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: