Pudusseri, Lisa

Pudusseri, Lisa is an individual health care provider with primary practice located at 12255 S 80Th Ave Ste 205 , Palos Heights IL 60463-1284. She recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as her primary health care specialty. Pudusseri, Lisa can be contacted via phone (708) 923-4200.

Contact Information

Primary practice address
12255 S 80Th Ave Ste 205 Palos Heights IL 60463-1284
Phone: (708) 923-4200
Fax: (708) 923-4201
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 036135453 Illinois

Profile Details

NPI number 1245422666
LBN Legal business name Pudusseri, Lisa
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 10th, 2007
Last updated Mar 1st, 2022 - about 2 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 1245422666 NPPES
Illinois MEDICAID 036-135453

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