Provider Demographics
NPI:1952311151
Name:FALK, LISA WENDY (DO)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:WENDY
Last Name:FALK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 SAINT CHARLES WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-5338
Mailing Address - Country:US
Mailing Address - Phone:561-988-0152
Mailing Address - Fax:
Practice Address - Street 1:1613 NW 136TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2853
Practice Address - Country:US
Practice Address - Phone:800-437-2672
Practice Address - Fax:954-851-1758
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7163207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G45453Medicare UPIN
FL57440Medicare ID - Type Unspecified