Provider Demographics
NPI:1922195874
Name:GEFFROS, LISA MICHELE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MICHELE
Last Name:GEFFROS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3270 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-2325
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1221 PINE GROVE AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3511
Practice Address - Country:US
Practice Address - Phone:810-989-3231
Practice Address - Fax:810-985-6061
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIL283125207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G87060Medicare UPIN