Provider Demographics
NPI:1669364931
Name:BEHNKE, LISA MARIE
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:BEHNKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19647 CASA VERDE WAY
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33967-0512
Mailing Address - Country:US
Mailing Address - Phone:305-215-3076
Mailing Address - Fax:
Practice Address - Street 1:19647 CASA VERDE WAY
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33967-0512
Practice Address - Country:US
Practice Address - Phone:305-215-3076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-19
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100479207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine