Provider Demographics
NPI:1285631218
Name:BURROUGHS-THUMI, LISA LISSETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:LISSETTE
Last Name:BURROUGHS-THUMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 AL HIGHWAY 75 N
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35951-3838
Mailing Address - Country:US
Mailing Address - Phone:256-891-0300
Mailing Address - Fax:256-891-7461
Practice Address - Street 1:460 AL HIGHWAY 75 N
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35951-3838
Practice Address - Country:US
Practice Address - Phone:256-891-0300
Practice Address - Fax:256-891-7461
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD33241208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL178784Medicaid
AL51168235OtherBCBS
FL261364600Medicaid
FLBB7288447OtherDEA
FLI49341Medicare UPIN
FL01114870OtherAMERIGROUP
FL46010OtherBC/BS
FL192304(A)OtherSTAYWELL