Individual
LISA COLLAZZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1475 NW 12TH AVE, MIAMI, FL 33136-1002
(305) 243-5512
Mailing address
1475 NW 12TH AVE, MIAMI, FL 33136-1002
(305) 243-5512
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME143682
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0175110
—
PA
Enumeration date
09/13/2005
Last updated
10/09/2024
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