MEDICARE: LISA CHRISTIAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1114665940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA CHRISTIAN MD

Provider Business Mailing Address
First Line	:	3344 PLEASANT WILLOW CT
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-8191
Country	:	US
Telephone Number	:	727-277-3595
Fax Number	:

Provider Business Practice Location Address
First Line	:	3344 PLEASANT WILLOW CT
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-8191
Country	:	US
Telephone Number	:	727-277-3595
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2022
Last Update Date	:	09/26/2022

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