MEDICARE: DR. LISA M POMERLEAU MD

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	207R00000X	Internal Medicine Physician	35068372	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	:	1235160599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA M POMERLEAU MD

Provider Business Mailing Address
First Line	:	3301 MERCY HEALTH BLVD
Second Line	:	STE. 340
City	:	CINCINNATI
State	:	OH
Zip	:	45211-1105
Country	:	US
Telephone Number	:	513-981-5922
Fax Number	:	513-385-6430

Provider Business Practice Location Address
First Line	:	3301 MERCY HEALTH BLVD
Second Line	:	STE. 340
City	:	CINCINNATI
State	:	OH
Zip	:	45211-1105
Country	:	US
Telephone Number	:	513-981-5922
Fax Number	:	513-385-6430

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	12/23/2016

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