LISA EDGERTON DO PA
Osteopathic Medicine at 107 St, Miami, FL

License number
Florida OS 8636
Category
Osteopathic Medicine
Type
Adult Medicine
Owner
Name: DR. LISA M EDGERTON D.O.
Title: PRESIDENT
Phone: (786) 390-8684
Address
Address
114 NE 107Th St, Miami, FL 33161
National Provider ID: 1366615254
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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LISA EDGERTON, D.O., PA

Fort Lauderdale, FL  -  Okemos, MI  -  Miami, FL

Registration:
Jan 6, 2003
Addresses:
14065 S Cypress Cv Cir, Fort Lauderdale, FL 33325 (Physical)
1843 Mirabeau Dr, Okemos, MI 48864
114 NE 107 St, Miami, FL 33161
State ID:
P03000001713
Business type:
Florida Profit Corporation
Osteopathy, Owner, President, Secretary, Vice President:
Lisa M Edgerton (Osteopathy, Owner, President, Secretary, Vice President), 114 NE 107 St, Miami, FL 33161 (Physical)
Agent:
Dade County Corporate Agents, Inc,20801 Biscayne Blvd SUITE 505, Miami, FL 33180 (Physical)
EIN:
542091535

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