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General NPI Number Information
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NPI Number | 1720324445
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Entity Type | Organization
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Legal Business Name | LISA L CUMMINGS, DPM, P.A.
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Dates
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Enumeration Date | 12/28/2012
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Last Update Date | 12/28/2012
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Provider Practice Location Address
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Address Line | 218A E EAU GALLIE BLVD # 163
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-4875
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Country | US
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Telephone | 321-615-5220
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Fax | 321-777-4340
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Provider Business Mailing Address
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Address Line | 218A E EAU GALLIE BLVD # 163
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-4875
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Country | US
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Telephone | 321-615-5220
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Fax | 321-777-4340
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LISA L CUMMINGS
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Credential | D.P.M.
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Telephone | 321-615-5220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 3248
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License Number State | FL
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