Provider Demographics
NPI:1518900844
Name:MACHADO, LISA (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MACHADO
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 1:9580 SW 107TH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2792
Mailing Address - Country:US
Mailing Address - Phone:305-381-0442
Mailing Address - Fax:305-456-0865
Practice Address - Street 1:9580 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2789
Practice Address - Country:US
Practice Address - Phone:305-381-0442
Practice Address - Fax:305-456-0865
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74277208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL322421OtherWELLCARE
FL43956OtherBCBS
FL260854500Medicaid
FL43956OtherBCBS
FL322421OtherWELLCARE