Provider Demographics
NPI:1073755286
Name:WHALEY, LISA MICHELLE (DPM)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MICHELLE
Last Name:WHALEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 NE MIAMI CT
Mailing Address - Street 2:UNIT 602
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132
Mailing Address - Country:US
Mailing Address - Phone:305-321-4910
Mailing Address - Fax:
Practice Address - Street 1:1741 NE MIAMI CT
Practice Address - Street 2:602
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132
Practice Address - Country:US
Practice Address - Phone:305-321-4910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3270213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist