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NPI Code Detail

MEDICARE: DR. LISA ANN MANSUETO M.D.

MEDICARE: DR. LISA ANN MANSUETO 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
1207W00000XOphthalmology Physician23840AZ
2207WX0200XOphthalmic Plastic and Reconstructive Surgery Physician23840AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13743063OTHERAZCIGNA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396742797
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA ANN MANSUETO M.D.
Provider Business Mailing Address
First Line : 3200 S COUNTRY CLUB WAY
Second Line :
City : TEMPE
State : AZ
Zip : 85282-4054
Country : US
Telephone Number : 480-839-0206
Fax Number : 480-831-6735
Provider Business Practice Location Address
First Line : 3200 S COUNTRY CLUB WAY
Second Line :
City : TEMPE
State : AZ
Zip : 85282-4054
Country : US
Telephone Number : 480-839-0206
Fax Number : 480-831-6735
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2005
Last Update Date : 05/09/2016

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