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NPI Code Detail

MEDICARE: LISA THORSON WAHLESTEDT MD

MEDICARE: LISA THORSON WAHLESTEDT 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
12083P0901XPublic Health & General Preventive Medicine PhysicianME 104170FL

General Provider Information

NPI Number : 1225267750
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA THORSON WAHLESTEDT MD
Provider Business Mailing Address
First Line : 212 AUSTRALIAN AVE
Second Line :
City : PALM BEACH
State : FL
Zip : 33480-4626
Country : US
Telephone Number : 561-835-3875
Fax Number :
Provider Business Practice Location Address
First Line : 212 AUSTRALIAN AVE
Second Line :
City : PALM BEACH
State : FL
Zip : 33480-4626
Country : US
Telephone Number : 561-835-3875
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2009
Last Update Date : 07/06/2009

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Directions to “ LISA THORSON WAHLESTEDT MD” Practice Location

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