Individual
LISA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10320 N PORT WASHINGTON RD, MEQUON, WI 53092-5767
(262) 241-1919
(262) 241-9046
Mailing address
788 N JEFFERSON ST STE 300, MILWAUKEE, WI 53202-3710
(414) 272-8950
(414) 274-6250
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
70489
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1619354743
—
WI
Enumeration date
04/27/2015
Last updated
08/07/2024
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