MEDICARE: LISA LARKIN, MD,LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207V00000X	Obstetrics & Gynecology Physician
2	363LA2100X	Acute Care Nurse Practitioner
3	363AM0700X	Medical Physician Assistant
4	207R00000X	Internal Medicine Physician

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	CK3758	OTHER	OH	RR MCR

General Provider Information

NPI Number	:	1376532879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA LARKIN, MD,LLC

Provider Business Mailing Address
First Line	:	1315 SOLUTIONS CENTER
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-1003
Country	:	US
Telephone Number	:	513-421-3504
Fax Number	:	513-231-7055

Provider Business Practice Location Address
First Line	:	4460 RED BANK EXPY
Second Line	:	SUITE 100
City	:	CINCINNATI
State	:	OH
Zip	:	45227-1548
Country	:	US
Telephone Number	:	513-271-5111
Fax Number	:	513-272-7084

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LISA C LARKIN
Credential	:	MD
Telephone Number	:	513-271-5111

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	02/26/2010

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