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General NPI Number Information
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NPI Number | 1508866765
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Entity Type | Individual
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Provider Name | LISSETTE E. TIRADO D.P.M.
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Gender | Female
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 08/27/2013
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Provider Practice Location Address
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Address Line | 625 BEAVER RUIN RD NW SUITE C
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City | LILBURN
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State | GA
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Zip | 30047-3467
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Country | US
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Telephone | 770-935-4443
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Fax | 770-935-4475
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Provider Business Mailing Address
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Address Line | 625 BEAVER RUIN RD NW SUITE C
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City | LILBURN
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State | GA
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Zip | 30047-3467
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Country | US
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Telephone | 770-935-4443
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Fax | 770-935-4475
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 000729
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 000729
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License Number State | GA
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