Provider Demographics
NPI:1609169721
Name:BIRKMEIER, LISA MARIE
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:BIRKMEIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50475 GRATIOT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-3128
Mailing Address - Country:US
Mailing Address - Phone:586-598-0050
Mailing Address - Fax:586-598-1804
Practice Address - Street 1:50475 GRATIOT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-3128
Practice Address - Country:US
Practice Address - Phone:586-598-0050
Practice Address - Fax:586-598-1804
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-6576Medicare UPIN