Burckhartzmeyer, Lisa Jean

Burckhartzmeyer, Lisa Jean is an individual health care provider with primary practice located at 228 Ne Jefferson St , Peoria IL 61602. She recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Psychiatry. Allopathic & Osteopathic Physicians / Psychiatry is her primary health care specialty. Burckhartzmeyer, Lisa Jean can be contacted via phone (309) 671-8000.

Contact Information

Primary practice address
228 Ne Jefferson St Peoria IL 61602
Phone: (309) 671-8000
Fax: (309) 671-4695
Website:
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Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 036129370 Illinois

Profile Details

NPI number 1962674820
LBN Legal business name Burckhartzmeyer, Lisa Jean
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 31st, 2008
Last updated Feb 5th, 2016 - about 8 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 1962674820 NPPES
Illinois MEDICAID 036129370

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