Provider Demographics
NPI:1881860658
Name:SPURLOCK, LISA A (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:SPURLOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:129 E BRECKENRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1319
Mailing Address - Country:US
Mailing Address - Phone:248-543-5111
Mailing Address - Fax:248-543-5171
Practice Address - Street 1:22750 WOODWARD AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1777
Practice Address - Country:US
Practice Address - Phone:248-543-5111
Practice Address - Fax:248-543-5171
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010616842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry