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Organization
LIDET REAL CORPORATION
Active
Organization
LIDET REAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA M DETOURNAY DPM (OWNER/PODIATRIST)
(305) 710-1971
Entity
Organization
Contact information
Practice address
1611 NW 12TH AVE, MIAMI, FL 33136-1005
(305) 710-1971
Mailing address
1235 MARIPOSA AVE APT 2, CORAL GABLES, FL 33146-3252
(305) 710-1971
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
5133
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
029750000
—
FL
Enumeration date
10/22/2014
Last updated
08/12/2020
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