Provider Demographics
NPI:1528059540
Name:SPECK, LISA B (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:B
Last Name:SPECK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:32905 W 12 MILE RD
Mailing Address - Street 2:STE 400
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3342
Mailing Address - Country:US
Mailing Address - Phone:248-553-0335
Mailing Address - Fax:248-553-8945
Practice Address - Street 1:32905 W 12 MILE RD
Practice Address - Street 2:STE 400
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3342
Practice Address - Country:US
Practice Address - Phone:248-553-0335
Practice Address - Fax:248-553-8945
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2009-12-03
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Provider Licenses
StateLicense IDTaxonomies
MI4301039813207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1656809Medicaid
06317598111Medicare ID - Type Unspecified
MI1656809Medicaid