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General NPI Number Information
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NPI Number | 1174970198
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Entity Type | Individual
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Provider Name | LISANDRO MIGUEL MONTORFANO M.D
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Gender | Male
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Dates
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Enumeration Date | 05/19/2016
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 1002 N CHURCH ST STE 100
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City | GREENSBORO
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State | NC
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Zip | 27401-1447
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Country | US
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Telephone | 336-890-2210
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Fax |
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Provider Business Mailing Address
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Address Line | 110 19TH AVE S APT 1618TH
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City | NASHVILLE
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State | TN
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Zip | 37203-2717
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Country | US
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Telephone | 843-442-9845
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | TRN# 19647
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 2024-03284
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License Number State | NC
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