MEDICARE: JAMES EDWARD LISI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	35-06-1768-1	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023101391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES EDWARD LISI M.D.

Provider Business Mailing Address
First Line	:	125 E BROAD ST
Second Line	:	SUITE 114
City	:	ELYRIA
State	:	OH
Zip	:	44035-6429
Country	:	US
Telephone Number	:	440-329-5943
Fax Number	:	440-329-5949

Provider Business Practice Location Address
First Line	:	125 E BROAD ST
Second Line	:
City	:	ELYRIA
State	:	OH
Zip	:	44035-6429
Country	:	US
Telephone Number	:	440-329-5943
Fax Number	:	440-329-5949

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2006
Last Update Date	:	09/04/2008

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