Provider Demographics
NPI:1215197926
Name:CORAM, LISA M (DO)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:CORAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2300 HAGGERTY RD STE 2160
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2192
Mailing Address - Country:US
Mailing Address - Phone:248-859-2457
Mailing Address - Fax:248-859-2473
Practice Address - Street 1:2300 HAGGERTY RD STE 2160
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2192
Practice Address - Country:US
Practice Address - Phone:248-859-2457
Practice Address - Fax:248-859-2473
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2019-04-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI51010204682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry