Individual
DR. LISA ELLEN GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSTOM
Contact information
Practice address
6301 SUNSET DR, SUITE 201, SOUTH MIAMI, FL 33143-4818
(305) 669-2715
Mailing address
5120 CARILLO ST, CORAL GABLES, FL 33146-2060
(305) 740-5547
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AP2651
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP2651
ACUPUNCTURE PHYSICIAN LICENSE
FL
Enumeration date
06/20/2009
Last updated
06/20/2009
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