Provider Demographics
NPI:1265421481
Name:GOULARTE, LISA A (DO)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:GOULARTE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3310 SE 29TH ST
Mailing Address - Street 2:#300
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66605-2090
Mailing Address - Country:US
Mailing Address - Phone:785-270-7444
Mailing Address - Fax:
Practice Address - Street 1:3310 SE 29TH ST
Practice Address - Street 2:#300
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66605-2090
Practice Address - Country:US
Practice Address - Phone:785-270-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-33496207VB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VB0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200590510AMedicaid