Tirado, Lissette E.

Tirado, Lissette E. is an individual health care provider with primary practice located at 625 Beaver Ruin Rd Nw Suite C, Lilburn GA 30047-3467. She recently has 2 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Podiatrist, Podiatric Medicine & Surgery Service Providers / Foot Surgery. Podiatric Medicine & Surgery Service Providers / Podiatrist is her primary health care specialty. Tirado, Lissette E. can be contacted via phone (770) 935-4443.

Contact Information

Primary practice address
625 Beaver Ruin Rd Nw Suite C Lilburn GA 30047-3467
Phone: (770) 935-4443
Fax: (770) 935-4475
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 000729 Georgia
Podiatric Medicine & Surgery Service Providers / Foot Surgery 213ES0131X 000729 Georgia

Profile Details

NPI number 1508866765
LBN Legal business name Tirado, Lissette E.
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 28th, 2005
Last updated Aug 27th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508866765 NPPES
Georgia MEDICAID 000761736A

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