Provider Demographics
NPI:1285976290
Name:ZYLBERGLAIT LISIGURSKI, MIRIAM (MD)
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:
Last Name:ZYLBERGLAIT LISIGURSKI
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 1:21097 NE 27TH CT
Mailing Address - Street 2:STE 480
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1204
Mailing Address - Country:US
Mailing Address - Phone:305-466-4008
Mailing Address - Fax:786-428-1062
Practice Address - Street 1:21097 NE 27TH CT
Practice Address - Street 2:STE 480
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1204
Practice Address - Country:US
Practice Address - Phone:786-428-1059
Practice Address - Fax:786-428-1062
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME127719207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine