Provider Demographics
NPI:1679857379
Name:GERMAIN-GEORGE, LYSBETH L (DO)
Entity Type:Individual
Prefix:
First Name:LYSBETH
Middle Name:L
Last Name:GERMAIN-GEORGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LYSBETH
Other - Middle Name:L
Other - Last Name:GERMAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:20856 NW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2334
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5361 NW 22ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-8035
Practice Address - Country:US
Practice Address - Phone:305-696-9400
Practice Address - Fax:305-636-5155
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 11442207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004494700Medicaid
FLE77824Medicare PIN