Provider Demographics
NPI:1275323602
Name:MAIZE, LISA KAY (IBCLC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:MAIZE
Suffix:
Gender:
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24894 RAVINE CT # 2204
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-2432
Mailing Address - Country:US
Mailing Address - Phone:407-791-3455
Mailing Address - Fax:
Practice Address - Street 1:24894 RAVINE CT # 2204
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-2432
Practice Address - Country:US
Practice Address - Phone:407-791-3455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL-145779174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN