Mctavish, Lisa Michele
Mctavish, Lisa Michele is an individual health care provider with primary practice located at 1500 Salem St , Lafayette IN 47904-2164. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Mctavish, Lisa Michele can be contacted via phone (765) 448-8000.Contact Information
Primary practice address
1500 Salem St
Lafayette IN 47904-2164
Phone: (765) 448-8000
Fax: (765) 379-3312
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | 01044255A | Indiana |
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 01044255A | Indiana |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 01044255A | Indiana |
Profile Details
| NPI number | 1982673687 |
|---|---|
| LBN Legal business name | Mctavish, Lisa Michele |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 15th, 2006 |
| Last updated | Jan 27th, 2021 - about 3 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1982673687 | NPPES |
| Indiana | Other | 000000990880 | ANTHEM PROVIDER NUMBER - DERMATOLOGY |
| Indiana | Other | 10825581 | ANTHEM PROVIDER NUMBER - DERMATOLOGY |
| Indiana | Other | 000000877221 | ANTHEM PROVIDER NUMBER - DERMATOLOGY |
| Indiana | Other | 000000197894 | ANTHEM PROVIDER NUMBER - DERMATOLOGY |
| Indiana | MEDICAID | 200083620 | ANTHEM PROVIDER NUMBER - DERMATOLOGY |
| Indiana | Other | 9007117 | ANTHEM PROVIDER NUMBER - DERMATOLOGY |
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