Individual
DR. LISA SUSAN MATTAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
521 RANCH RD, WESTON, FL 33326-1757
(305) 799-2248
Mailing address
521 RANCH RD, WESTON, FL 33326-1757
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
E-9356
AR
208M00000X
Hospitalist Physician
Primary
E-9356
AR
Other
Enumeration date
04/19/2013
Last updated
03/31/2021
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