Provider Demographics
NPI:1851178024
Name:RIVERA NUNEZ, LIZMAR (MD)
Entity Type:Individual
Prefix:
First Name:LIZMAR
Middle Name:
Last Name:RIVERA NUNEZ
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:PO BOX 430150
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48343-0150
Mailing Address - Country:US
Mailing Address - Phone:248-724-7600
Mailing Address - Fax:248-857-7141
Practice Address - Street 1:1200 N TELEGRAPH RD BLDG 34E
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1032
Practice Address - Country:US
Practice Address - Phone:248-724-7600
Practice Address - Fax:248-857-7141
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351052054207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine