Provider Demographics
NPI:1508043894
Name:CAMPBELL, LISA M (RT)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
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Mailing Address - Street 1:27207 LAHSER
Mailing Address - Street 2:STE 200B
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-8471
Mailing Address - Country:US
Mailing Address - Phone:248-663-1900
Mailing Address - Fax:248-663-1902
Practice Address - Street 1:27207 LAHSER
Practice Address - Street 2:STE 200B
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8471
Practice Address - Country:US
Practice Address - Phone:248-663-1900
Practice Address - Fax:248-663-1902
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OMO8420Medicare UPIN