Provider Demographics
NPI:1447259486
Name:LISTER, MICHELLE L (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:L
Last Name:LISTER
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3801 BISCAYNE BLVD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-9800
Mailing Address - Country:US
Mailing Address - Phone:305-571-0620
Mailing Address - Fax:305-576-8099
Practice Address - Street 1:21097 NE 27TH CT
Practice Address - Street 2:SUITE 100
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1204
Practice Address - Country:US
Practice Address - Phone:305-792-0012
Practice Address - Fax:305-792-0030
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2022-02-09
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Provider Licenses
StateLicense IDTaxonomies
FLME69939207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260903700Medicaid
FL260903700Medicaid