Provider Demographics
NPI:1508822578
Name:BENZ, LISA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:BENZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANNE
Other - Last Name:TUMEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5361 WALNUT CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9477
Mailing Address - Country:US
Mailing Address - Phone:734-395-2177
Mailing Address - Fax:
Practice Address - Street 1:6327 BURLINGAME ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204-1301
Practice Address - Country:US
Practice Address - Phone:734-395-2177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078835208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics