Provider Demographics
NPI:1003809450
Name:TOMSAK, LISA A (DO)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:TOMSAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:COSTARIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4036 ARTESA DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-2628
Mailing Address - Country:US
Mailing Address - Phone:570-466-5757
Mailing Address - Fax:
Practice Address - Street 1:1590 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-5957
Practice Address - Country:US
Practice Address - Phone:570-466-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0068878207RA0401X
NVDO3188207RA0401X
CA18636207RA0401X
IN02005078A2083A0300X
FLOS142192083A0300X
PAOS007618L207RA0401X
IL036162516207RA0401X
AZ0071792083A0300X
WAOP607078742083A0300X
NJ25MB11582500207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013931090006Medicaid
F44476Medicare UPIN
PA0013931090006Medicaid