Provider Demographics
NPI:1902097413
Name:MAO, LISA KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA KAY
Middle Name:
Last Name:MAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5560 NW 38TH TER
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4132
Mailing Address - Country:US
Mailing Address - Phone:954-648-4929
Mailing Address - Fax:
Practice Address - Street 1:1445 NW BOCA RATON BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1610
Practice Address - Country:US
Practice Address - Phone:561-997-8100
Practice Address - Fax:561-338-7785
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60043174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14995WMedicare PIN
FLF27109Medicare UPIN