Mullally, Lisa Denise

Mullally, Lisa Denise is an individual health care provider with primary practice located at 11275 Delaware Pkwy , Crown Point IN 46307-7812. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Mullally, Lisa Denise can be contacted via phone (219) 779-8735.

Contact Information

Primary practice address
11275 Delaware Pkwy Crown Point IN 46307-7812
Phone: (219) 779-8735
Fax: (877) 715-2312
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 02003098 Indiana

Profile Details

NPI number 1861462012
LBN Legal business name Mullally, Lisa Denise
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 23rd, 2006
Last updated Mar 25th, 2019 - about 5 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 1861462012 NPPES
Indiana MEDICAID 200833870
Indiana Other 000000721919

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