MEDICARE: DR. LISA RENE GNAS D.O.

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	5101013946	MI
2	208D00000X	General Practice Physician	5101013946	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5101013946	OTHER	MI	MICHIGAN LICENSING AND REGULATORY AFFAIRS

General Provider Information

NPI Number	:	1437318243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA RENE GNAS D.O.

Provider Business Mailing Address
First Line	:	5820 N CANTON CENTER RD STE 181
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-2651
Country	:	US
Telephone Number	:	877-882-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	5820 N CANTON CENTER RD STE 181
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-2651
Country	:	US
Telephone Number	:	877-882-4800
Fax Number	:

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

Provider Enumeration Date	:	06/06/2008
Last Update Date	:	10/03/2023

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